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.r, w " Rl\SIWH:ffi 2660 CIVIC CENTER DRIVE ROSEVILLE, MINNESOTA 55113 PHONE: (651) 490-2279 FAX: (651) 490-2931 (City Code is available on the Internet. The address is: www.ci.roseville.mn.us). Please check item or items for which you are applying: X PUD $750 Comprehensive Plan Amendment $750 ReWiiing $300 Minor Subdivision $100 Conditional Use Permit $200 Relocation of Dwelling $100 Vacation of Right-of-Way $200 Variance to Zoning Ordinance $200 Preliminary & Final Plat $500 Interim Use Permit $200 Labels to Affected Property Owners ($35.00 + $.25/1ab:1) When applying for more than one approval, only one fee (the highest) is charged. Please complete form by typing or printing in ink. If the spaces provided are insufficient, use additional sheets, keying information to the proper item numbers: 1. ja~~) ~. 8 ~~~.\t\ A. Name of Owner: (First) (Middle) ~~ ~,,\ d~V) (No. And Street) (City) ~ ba\}~ (Middle) 2. 3. <.Sa ~ Cl S. Name of Applicant: (First) 4. 5. Address of Applicant: (No. And Street) Q~ " W C;>$.1' CDu.~ <?n ~ d c.- ~ Street Address of Property Involved: 6. 7. Present Use of Property: ~mMtR.Q~~tc.\-.""\\8. Proposed Use ofProperty:~\ ~ II' \ a. \ 'S Q YY\.Q. Present Comprehensive Plan Designation: Proposed Comprehensive Plan Designation: 9. 10. What plan or change makes this request necessary? at- ~~ \ l ~ ,\, d \ 1 ~ 3 ast) (Last) (Phone) (City) (State) (Zip) ~$Q V\ \lo ) hfN 551) 3 ~Q t~e~ , Present Zoning of Property: 1- Q Proposed Zoning of Property: ~nd 30.000 ~ I I