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� <br />--� <br />� <br />'�J� <br />� <br />COMMUNITY DEVELOPMENT <br />2660 Civic Center Drive ❖ Roseville, MN 55113 <br />Phone: (651) 792-7005 ❖ Fax: (651) 792-7070 <br />� C����d� <br />Ja�� �;E ��;� <br />� <br />ADMINISTRATIVE DEVIATION APPLICATION <br />CITY CODE SECTION 1014.05 <br />www.ci.roseville.mn.us <br />❑ APPLICATION FEE: $100 <br />Fc e shou/d be rnude payable to Citl• ofRoserille upon submittal of comp/eted 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: ��y�C:� <br />_� <br />Address: =;���� (',C�niz.i i�c;� 3(.�.j-�� City/State/Zip: �G�'-il��-�4 F�1/U ��51/3 <br />Pltone number: �U - 3Lj�-S5� 1 Email address: qir�G�.0 C�;>�ciP�Ot.aJ. GlYYI <br />U <br />2. Applicant Information: (if different from above) <br />Company name: `�m.,P C �� C�b� �1�. <br />Last name: <br />Address: <br />Phone number: <br />First name: <br />City/State/Zip: <br />Email address: <br />3. Statement of Intent: Briefly describe the project: why is an Administrative Deviation needed? <br />!'.� S - <br />� h�� <br />4. Additional Required Information: <br />�_ � �� h1�5 r'h �;�� <br />��: n <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 miti�ation 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 />§ 1014.05 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 On�ner: a,� �� �j� � <br />� <br />Applicant: _�'�'� � � ���1 Q <br />Date: (v��11� C� <br />Date: �i��-{�/0 <br />