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�i�'� '� , <br />��► <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE <br />ROSEVILLE, MINNESOTA 55113 <br />PHONE: (651) 490-2279 FAX: (651) 490-2931 <br />(City Code is available on the Internet: www.ci.roseville.mn.us). <br />SETBACK PERMIT APPLICATION <br />(CITY CODE SECTION 1013.05) <br />. � ;-� p,��-- _ <br />,�1,; RESIDENTIAL PROPERTY OWNER FEE - �5- � ; <br />' (All fees payable upon submittal of completed application) } �� ` ''� 'rR'' � � ��" <br />Please complete the application by typing or printing in ink. If the spaces provided are insufficient, use <br />additional sheets, keying information to the proper item numbers: <br />1. <br />2. <br />Na�ne of O�vne��: (First) (Middle) (Last) (Phone) <br />.(� � Gr��''/L- �J � ��G'`✓�!���.- V .� � - ���" J `' ,� / � / L J, <br />! <br />Address of Or��ner: (No. And Street) (City) (State) (Zip) <br />, <br />.;� a�, .��., , �k,����� CS��- ���-�y- IY��� <br />3. Name ofApplicant: (First) (Mid�le) <br />oZ `% � � ��l a�'u-��vi� c� <br />4. Address ofApplicant.• (No. And St��eet) (City) <br />5. <br />6. <br />� <br />� i 9� �����.�,-�- - �-�' <br />St��eet Address of Property Involved: <br />(Last) (Phone) <br />:� ; .� � �j � <br />(State) (Zip) <br />�%Lrl-Z ..�`J^I L 3 <br />State exactly what is intended to be done on or with the property that requires the setback <br />permit: <br />�Vl 0�l.��IQ � fi_ICM ��A r�" " 1 IL�. �� L ItiVtJL(.�.r I►'1 }}��� ��l fP��-�'fi' i�� ,��f Uk' ��: <br />� . <br />, ,: � <br />Explui» alternatii�es that have been examined which would enable you to meet existing Code <br />requirements: <br />Page 1 of 3 <br />