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<br /> <br />crrY OF rosE'v'"ILIE <br />2660 CIVIC cn.~ I:RIVE <br />REE\.'IU.E, ~ 55113 <br /> <br />Please chECk item or it5:!s f<:1r ;.t..ic:h yol are a~ly:L."'X;: <br /> <br />Mi..~ 'Ila..-iance: ari.l~ CI't'" nc:n rotcrizecl pat:...':-~'Y <br />1- Kiror v'arianc:e: Driv-a.:ay <br /> <br />~ S/iUt'-!- .........-..,.... <br />~:.OO <br /> <br />Please c:a:plete !om by tz-pin; cr pr'....nting i.'" ir.k. If t!-~ spa02S provided are <br />i.nsufficient, use ad:1itio."13l ~..s. Ke-ji.TJ;! i.nf.)r.:aati~ to the p...-rcper itsu ~: <br /> <br />1. <br /> <br />~ e. I ',.j', <br />Na=!e or ~: <br /> <br />(Middle; <br /> <br />-: :'~' ,', <br /> <br />. . <br />! ~ : ',-', ..; t' ~ ~ :... /j (';. J( <br />(last. ) <br /> <br />~1 i7 - f'; i i <br />{Phone} <br /> <br />(First) <br /> <br />2. <br /> <br />". <br />.:;1:'... :: ... t.;: '..1- . k i 't <br />Address cf o;"n&: ' <br /> <br />{stat.:!] <br /> <br />r: <br /> <br />'~ . - " i 3 <br />(Zip) <br /> <br />: ~ "'\ <br /> <br />... ,t <br /> <br />~. am street, <br /> <br />(City) <br /> <br />3. <br /> <br />; i . '_'': , . ~ h (. .~ <br />, (last) <br /> <br />. -.. <br />~~. .-~,'" '. <br />{B1ar.e} <br /> <br />111... f. . '. -rt~ <br />~~f 'Awlica.-,t): {Fi..T"St:.} <br /> <br />""!.. <. <br /> <br />Qt...i.c:Ul~) <br /> <br />4. <br /> <br />.:::....:.' . ---!", " .,. "! . .J 1 r,:: ,~ '-., t <br />(],d-jress 'of' ir.Pl'-'.); , (No. an:i Strget~ {City) <br /> <br />{State) <br /> <br />ro"", <br /> <br />.- - .... <br />~ ~ '. \" <br />. (ZiP) <br /> <br />5. <br /> <br />z ~ ......~ PI"',,;,,~. <br />street Address of ~.rt"i :i:n-.>o).'\.reG: <br /> <br />6. C:z!plete Legal t\?scriptiCl'l af Prq:e.rt}, L""i'J'Olved: / 3 . '2 f- z. J - I'Z. - o';'-r- ~ <br /> <br />? . Pre&m Use of Propeny: I? - i <br />s. Present ~-ani."XJ of ~: It--./ <br /> <br />9. '.''U'::a!"0? is ~:€':'=-:'9C f!"'1C' +-,!--~ f('ll,"'i~ :<:o?-~i~1!"t~S) of t.'1e ~it:y c:rle: n~ <br /> <br />10. Infornatioo ..tl.ich 13JSt re ~ttcd fer aU ar:plicat..icn;: <br /> <br />A.. ~1--'~~""""" :-:..:...-: :-:-:: ~i~ <br /> <br />5. <br /> <br />S-l/~ x 11" Si~ c'la.., s..~cr,';Li'X] pr-...:-~y <br />a..-rl p~~ .i=+~.."t'.~t:.s.. <br /> <br />existL-x; <br /> <br />lll"'~""'.S, <br /> <br />~~ <br /> <br />l~~.:.c::. <br /> <br />....~ <br />'-,. <br /> <br />all <br /> <br />,.. <br />.... <br /> <br />\\yi t~c.~ ,::rprV';,,"al fr-~ ~~-s <br />t,;,~c \'.:u.-i..\:.,---c rtX1..1t.?st., <br /> <br />ot ;.:d-..1~i~ <br /> <br />,~- <br />-'. <br /> <br />!:t!a.l-::~. c'!.""'C':oe~~:..cs aff~-tcrl by <br /> <br />D.. <br /> <br />1\':-:' tt.C!\ st:...")t::'Z7'.~~t.s <br /> <br />.J.FP 1. i.':":Ui~. <br /> <br />~~.i.J~-:i.:-:'C <br /> <br />~"---' ....~ '"'> <br />.............. ~...~ <br /> <br />.-+.., <br />.......} <br /> <br />t..r~Q ....~..1r::~~ <br /> <br />~s <br /> <br />!~~_"'.=.{::K,1::' .~. ."L,""):: ~,1~: ~---~:::..~:t=..s. ;~r-t...~ ~:--":-&2':-;:.. <br /> <br /> <br />