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� <br />1.%�►�� <br />� <br />COMMUNITY DEVELOPMENT <br />2660 Civic Center Drive ❖ Roseville, MN 55113 <br />Phone: (651) 792-7005 •'r 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 Ciry of Rosei�ille upon submittnl 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: First name: <br />Address: ��'' S6 yk,, /-�Je. City/State/Zip: <br />Phone number.• �6 5 � � 6`f `% O 2 S�J Email address <br />2. Applicant Information: (if different from abovc) <br />Company name: <br />Last name: <br />Address: <br />Phone number: <br />First name: <br />City/State/Zip: <br />G �,� G� <br />l��'5��;1(e vf+� SSi�� <br />Email address: <br />KG-R�.�v, � c�.,� ����: �v�� <br />3. Statement of Intent: Briefly describe the project: why is an Administrative Deviation needed? <br />l, f.✓C��,�s�m�'�7 ��✓7� ,5��7 a� t� ��:� G�-�c,�-�� S.9e �- wc5,'/ <br />2, i� D c-n ✓, �:, 3 C �,� ,z ,4-� � �,,�, .�s <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 preliminarv 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 . <br />Property Owner: �.�- Date: � I� �/ — o r <br />Applicant: S✓-l-rii� <br />Date: <br />