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•.. <br />1`�,�./,,,, <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 />i-• _ ,, , _ ; ;7 � y� �' ^ <br />Last name: �'(��:���-�( '� �' � First name: .'�l �1� t �{i �-t5 <br />Address: ��C��� �-{E %�SC tlE L �"7 . Ciry/State/Zip: !��`S_ C� �;,.c�;,� `j 5/%?� <br />Phone number: � �5 � - �' �( � �� � �' �� Email address: <br />2. Applicant Information: (if different from above) <br />� <br />Company name: ,( ;' �j � � I,'t�t - ,+,,% �"�E-rn- <br />Last name: � C��'� �� First name: f� rt �'E`��� <br />Address: r? - 2��' (G'CP�'c..�'(�L �L `�-" City/State/Zip: 5% ��c i c ,/.�.Prt! °; S"� �l % <br />Phone number: c , � <br />�� �Z �5 c' � - 7`S� C % Email address: �4 C'Y'� ��� c,r 5..��� ��. ,�rr-�� <br />3. Statement of Intent: Briefly describe the project: why is an Administrative Deviation needed? <br />� <br />� zX3�. <br />- �i�.( c� � -r ,� :{ � -- ;` ;' { _ <br />��,�G !% �liL� it L 5 CC !, L�--- t'' k C t� t' <' � L`�I � k C lwC �� vs— L i L Y c >�- c� �<<- <br />nti�c'�// .i r <br />4. Additional Required Information: <br />a. 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 />2) Include qreliminary storm water mitigation plans with impervious coverage deviations. <br />b. 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 knowledge. <br />Properry Ow,�er: ,�,;�., � �«� <br />Applicunt: <br />� <br />Date: r� � tr� <br />Date: l C� l � `�� <br />