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~~@~ow~m ill] .~~ 1 7 ~001 W By ~..,- ROSEVILLE, MINNESOTA 55113 PHONE: (651) 490-2279 FA~; \U;.JJ} ..~u~ } (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 _ Comprehensive Plan Amendment _ Rezoning $300 _ Minor Subdivision _ Conditional Use Permit $200 _ Relocation of Dwelling _ Vacation of Right-of-Way $200 X. Variance to Zoning Ordinance _ Preliminary & Final Plat $500 _ Interim Use Permit ~ Labels: Affected Property Owners ($45.00) ~SIWfbbE '.' 2660 CIVIC CENTER DRIVE $750 $100 $100 $200 $200 '\ao 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. 1GA,.rv I /'1. (\?UA~SECiL Lur/DELl... ~S-I-~<t'? -6~rt.f Name of Owner: (First) (Middle) (Last) (Phone) 2. I f? c7--g f2-y /1 rJ I2-t> S-CII' ~c $'S//3 I Address of Owner: (No. And Street) (City) (State) (Zip) 3. $f\kE {J$ ~I Name of Applicant: (First) (Middle) (Last) . (Phone) 4. SAM € ~ s #;;;L Address of Applicant: (No. And Street) (City) (State) (Zip) 5. I ? J--g fZ-y 14 ,.J Street Address of Property Involved: 6. Complete Legal Description of Property Involved: 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? /2e:f'o1d De.~llllb 1