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City of Da~SBVfbbE .I.~ . Minnesota 2660 Civic Center Drive Roseville, Minnesota 55113 Phone: 651-490-2279 Fax: 651-490-2931 E-mail: dennis.welsch@ci.roseville.mn.us (City Code, Zoning Map and Comprehensive Plan Map are available on the Internet at: www.cLroseville.mn.us) PF# Please check item or items for which you are applying: PUD Rezoning of Site Zoning Text Amendment Vacation of Right-of-Way .-X- Vacation of Easement Preliminary & Final Plat $750 $300 $300 $200 $200 $500 Comprehensive Plan Amendment$750 Conditional Use Permit $200 Minor Subdivision $100 Relocation of Dwelling $100 Variance to Zoning Ordinance $200 Interim Use Permit $200 Mailing Labels $35.00 + $.25/label When applying for more than one approval, only one fee (the highest) is charged. Please complete this form by typing or printing in ink. If the spaces provided are insufficient, use additional sheets and refer the information to the proper page and item number. All applicable items must be completed and all required information attached for the application to be accepted as complete. In order to be considered by the Planning Commission and City Council, the applicant must be present at the meetings. 1. t<'}Ow'" ~~e..s USJ ~c... Name of Owner: (First) (Middle) 2. '90t> 5<!.t' -">....rl. Av~ 14 '# 700 Address of Owner: (No. And Street) 3. S-e Name of Applicant: (First) 4. So..-.... Address of Applicant (No. And Street) 5. Mds ~City) (Last) (Phone)(Fax) MN .sS,"/o;J.. (State) (Zip) (Last) (Phone)(Fax) (Middle) (City) (State) (Zip) Street Address of Property Involved: 6. Complete Legal Description & Pin Number of Property Involved (may attach): loT b '6\cc..~ \ Ce-.~<. t6 f ""+ ~i",e.."7S 7~ 7. Present Use of Property: ~ckvc...lD~A Proposed Use of Property: ~,,"e..r-c:..c__\ ~~L Page I of 5