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, I ." . I. .Sf31VIbbE 2660 CIVIC CENTER DRIVE ROSEVILLE, MINNESOTA 55113 PHONE: (651) 490-2279 FAX: (651) 490-2931 (City Code is available on the Internet: www.ci.roseville.mn.us). Planning File: Please check item or items for which you are applying: PUD $750 _ Rezoning $300 --/' Conditional Use Permit $200 ~ Vacation of Right-of-Way $200 Preliminary & Final Plat $500 Labels: Affected Property Owners ($45.00) Comprehensive Plan Amendment Minor Subdivision Relocation of Dwelling Variance to Zoning Ordinance Interim Use Permit $750 $100 $100 $200 $200 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. ~'-A-~ Name of Owner: of- (First) ('f\ l (\.jN~ D-rA- (Middle) (D 0,- '] (Last) (Phone) 2. \ 5C)(:) LJ~'S, Cou ~W ~AC &-2 RO~lLL.t- 55 ( l 3 Address of Owner: (No. And Street) (City) (State) (Zip) 3. 'S A-ME... Name of Applicant: (First) (Middle) (Last) (Phone) 4. Address of Applicant: (No. And Street) (City) (State) (Zip) 5. Street Address of Property Involved: 6. Complete Legal Description of Property Involved: Sf:.f:..~.o \ 1.=C.M O~~PTlDr--J 7. Present Use of Property: Proposed Use of Property: 8. Present Zoning of Property: Proposed Zoning of Property: 9. Present Comprehensive Plan Designation: Proposed Comprehensive Plan Designation: 10. What plan or change makes this request necessary?