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��+� °� . •. _ . <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 ea�.ec,k- --- <br />Cl RESIDENTIAL PROPERTY OWNER FEE - S�5- � , <br />. ��,►_. �_.1��. �� �..F��,�{ <br />(All fees payable upon submittal of completed application) <br />Please complete the application by typing ar printing in ink. If the spaces provided are insufficient, use <br />additional sheets, keying information to the proper item numbers: <br />1. Nan7e of Oivne�� <br />2. Add�•ess of O�1�ner: <br />(v Z5 <br />3. Name of Applicant <br />(First) (Middle) (Last) <br />N�A�I�M ftl�SHf�;IF <br />(No. And St��eet) (City) (State) <br />S��fih Gwc�sso l�l�c� . �cSe���l� ►'1'�� <br />(First) (Middle) <br />m�2 �A�� <br />4. Address ofApplicant: (No. And Street) (City) <br />(Last) <br />��s+-�.��ei F <br />(State) <br />(Phone) <br />(Zip) <br />5� � i 3 <br />(Phone) <br />(Zip) <br />l�Z`� S �� i�1 ��;ctss�;� �� v� �GSe �2( (� �y1 ti° �j � � 3 <br />5. Street Add�•ess of Pirope��ty Involved.• <br />�Z5 S� u-ta�. ��-a.ss�� � � ���:� , �ES� ���' ► �� l�1 � 5S i I 3 <br />6. State exactly what is intended to be done on or with the property that requires the setback <br />permit: <br />i 4^t 0 �GU. � � i n �1 rm ���" `Z t'��? � � t vCtn��! .�. � i"� ";�.• � j � :� �� � �,i^,� p r � 9�� -�. <br />k � � <br />� ,.- ! � 1 . s-_ t..��:, � . � �. .� :1 I ' <br />i . �_, . 1 ( I'. ..:. <br />7. Expluin alteri�atii�es that have been examined which would enable you to meet existing Code <br />requirements: , <br />�1 <br />�� <br />� <br />� v��Y�-viC� CLt ci S�k bac.K �'-� f i v� {-eet <br />Page 1 of 3 <br />