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`/� � IIII� I� <br />J II <br />COMMUNI'Y'Y DEVELOPMEI�TT <br />2660 Civic Center Drive ❖ Roseville, MN 551 13 <br />Phone: (651) 792-7005 ❖ Fax: (651) 792-7070 <br />�. . � �� � <br />CITY CODE SECTION 1102 <br />www. ci.rosevill e.mn.us <br />APPLICATION FEE: S500 <br />ESCROW DEPOSIT: $1,500 <br />Application fee and escrow deposit should be made payable to City of Roseville upon submittal of completed application. <br />Escrow funds will be drawn to cover project-related costs. Additional funds may be required; surplus funds will be returned. <br />Please complete the application by typing or printing in ink. Use additional paper if necessary. <br />1. Property Owner Information: <br />�G fi`o,v u. �o � /m ` dl � <br />Company name: f/� o� y.s , <br />Last name: /1%0 .i' t c<,TT First name: O �u c n/ <br />Address: G 7oS G/'ti� Ir 1 e�e,�'/'Y 77'�, ( City/State/Zip: dvod��r*-q ,-k� -.�.�/e?�' <br />� <br />Phone number: G/J _ 7.�1 - 3/�� Email address: _�.� Cvo r r�. T� � y�� �oo • C� -- <br />2. Applicant Information: (if d�erent from above) <br />Company name: <br />Last name: <br />Address: <br />Phone number: <br />First name: <br />City/State/Zip: <br />Email address: <br />3. Address(es) of Property Involved: (if different from above) <br />�is /—S. �1�c1� i 7 �v��al` �1 `�'g rr�,r /���� ,�/ �3� <br />4. Zoning Designation: � � °� �� tir .�y �s. � � f � ,�� _ �/.�� v, %lj `� ° <br />5. Comprehensive Plan Designation: <br />6. Statement of Intent: Describe the properties to be combined or created as a part of t}us Preliminary <br />Plat application and indicate whether a variance, zoning change, andlor Conditional Use Permit will <br />be required for the proposed parcels or the intended use. <br />_.. <br />_. _ - - - <br />_. _. <br />� ° �5 / � °�_ 1 C�-r''/� ¢/l/I /'�.�� � s ��.� �s°-� s �.�� <br />3 ty ' <br />S - S. <br />%''-1 �1'J <br />�.�i�v�� [/a� /l!m/le <br />� <br />�r � <br />���y �B y'n�e rs . <br />� <br />? .,./� ��e <br />: <br />s ��p � v !/� r � <br />� <br />