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-� <br />1�`��, <br />�� <br />COMMUNITY DEVELOPMENT <br />2660 Civic Center Drive ❖ Roseville, MN 55113 <br />Phone: (651) 792-7005 •3 Fax: (651) 792-7070 <br />D��C�C('�l� <br />ADMINISTRATIVE DEVIATION APPLICATION <br />CITY CODE SECTION 1014.05 <br />www.ci.roseville.mn.us <br />❑ APPLICATION FEE: $100 <br />�;:� � � zo�o <br />Fee should be rnade puti•uble to Ciry of Roseville upon subntittal of �completed cipplicntion. <br />Please complete the application by typing or printing in ink. Use additional paper if necessary. <br />1. Property Owner Information: <br />Last name: :� �d �-t-So n First name: ���V� � <br />Address: 2 D�'`S� %Icv�i�v�� st- Ciry/State/Zip: /Z��v+ � �,e, j`1 J�! S S�l 13 <br />Phone number-: 6 � Z—$ 39--3%6 3 Email uddress: ,� � m� � Co f p�" -�► ��° <br />2. Applicant Information: (if different from above) <br />Company name: <br />Lust 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 />�rnp�r�r;��,ts Cv�;�� �ccerd3 ��v%, AISvi r�la�-;�elk ,����,v s��� �t�.�n �i4us�. <br />�"r�1e �vt c�(9t= ,h�.k�s yA�l��•,,� a fr��le+" cIr fF� ��It a; t►� a�;�11 S� s�f-bath. �`he bu5h I�n e <br />cilung 1•�F �S►.u-�� S�d�'. tt1�e3 a 5ic12 �ii?7'a.��E ���f�t�'J� cu�E� a�Sc r����3 �e �I'�'Jr.�+.YCyf 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 />§ 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 />Property Owner: 1 Y� t��"� <br />�—� a� C� <br />, <br />Daze: �z %�lC� <br />Applicant: Date: <br />