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� <br />1��,� <br />•/� <br />COMMUNITY DEVELOPMENT <br />2660 Civic Center Drive ❖ Roseville, MN 55113 <br />Phone: (651) 792-7005 ❖ Fax: (651) 792-7070 <br />ADMINISTRATIVE DEVIATION APPLICATION <br />CITY CODE SECTION 1013.05 <br />www.ci.roseville.mn.us <br />❑ APPLICATION FEE: $75 <br />(Fee should be made payable to City of Roseville upon submittal of completed application.) <br />Please complete the application by typing or printing in ink. Use additional paper if necessary. <br />1. Property Owner Information: <br />) <br />Last name: %% l/� �� .5 a�� First name: <br />Address: f � d .� ` � L � ��l � �-I(� l�l Ciry/State/Zip: <br />Phone number: �� ��- �,' E Z�� 1 Email address <br />2. Applicant Information: (ifdifferent,from above) <br />Company name: <br />Last name: <br />Address: <br />Phone number: <br />First name: <br />City/State/Zip: <br />Email address: <br />�� � <br />�� C�i_ 4'/� ! j;�; M-1 N��t S.S�I� <br />C '� c°- r.�� /J P �� -! tn'�' � '1 .- � .: � �/1 <br />-� ' <br />3. Statement of Intent: Briefly describe the project: why is an Administrative Deviation needed? <br />f� ,� , � , � � /_ - _�� � ,�. / <br />��_��.r � f - ��-�,�` ��. -��..� ; - <br />4. Additional Required Information: ' <br />�a. <br />b. <br />` r . L <br />�� <br />._ ! l/- <br />Proposed Plans: A scaled site plan is required showing the existing and proposed building <br />footprints as well as driveways, sidewalks, and patios. <br />1) Include elevation drawings showing the proposed addition or new building with structure <br />setback deviation applications. <br />�) Include preliminarv storm water mitigation plans with impervious coverage deviation .� ",' `,/,." f. <br />� � <br />Written Narrative: Address the factors that must be considered during review of Administrative <br />Deviation applications; these factors are listed in the document attached to this application and in <br />§ 1013.05 of the City Code. <br />5. Signature(s): By signing below, you attest that the information above and attached is true and <br />correct to the best of your knowle e. <br />Property Owner: �-}-„�� c--�:.�:•.�-e� Date: <br />Applicant: �� � � �%�'= �., � :� N Date: <br />�, : , <br />