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�ROM WPLSER BPG <br />(TUE)OCT 10 2000 11;21/ST.11:20/Ne.683'211"s26 P 1 <br />�JS <br />� <br />COMMUNITY DEVELOPMENT DEPARTM$NT <br />� <br />26611 C1VIC CBNT�R nRIVF, <br />ROSEVILLE, MINNESOTA 55113 <br />I'HONE: (651) 790-7005 FAX: (651) 792-7070 <br />(City Cudc is available pn the Interneh www.ci.roseville.mn.us) <br />INTEl21M USE PERMIT APPLICATION <br />(CITY CODE SEGTION 1012.09) <br />RESIDENTIAL P120PE12TY QWNEl2 FEE - S1S0 <br />BUSIN1�:55/1NDUSTRIAL FEF, - $550 <br />(All feee pnyeble upon submittnl ntcompk4d AppllCSdon) <br />Please complete the application by typing or printing in iizk. Ifthe spaces pruvided are insuflicient, ux <br />additional sheets, keying inti�rmatiun to the proper item numhers: <br />1 <br />2. <br />1Vnme uf Chvncr: <br />S� 9A� <br />�%WqCr: <br />(Arrst) (Middfe) <br />Y' �R�(�2 ( C'1 �� <br />(Na. And SlreetJ (Crty) <br />Y <br />(Las1) (Phonc) <br />(Stale) <br />�O -.� �✓asfiin/�TZn,� . -S �� �.4u� /rin�� <br />._i . <br />3. NurnenfAf�plicant� /Frrs�j (Middle% (l.�1s!) <br />r���sez (�PU .1��_ <br />4. Address qfAp��licnnr.• (No. Ri1d SlreelJ /Cily1 (Slule) <br />5. <br />6. <br />7. <br />S[reet Address ofPraneflv /nvolved. <br />(�iP) <br />�C�.� <br />(Phonc) <br />�Pi <br />Corr�p(e�cr Legu! Deecrip�ion uf Properly Invol��ed & PID 1�'0. (below or ariached): <br />J�<� /� � G�� <br />SIQ(L' L'XGCI�y WI1Gl 73 /!1!L'I7CIf-d !o be clone on or wilh !he praycrly Ihu! reyuires !he iruerim ure <br />�)ernut _ ' _ r., _ - l., <br />�1/Lr �--, r.Jr+�S^, .f.�C.1'�c+� . G�• Y1.Qtti/ T'(IU.C.> �,, 4UC..✓a�7, <br />/-aT"'. �"7 S 1�vta/ ? � rv . ��o�t } I 1 in✓ . <br />�� � <br />i�.�r i �ra <br />