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<br /> <br />2660 CIVIC CENTER DRIVE <br />ROSEVILLE, MINNESOTA 55113 <br />PHONE: (651) 490-2279 FAX: (651) 490-2931 <br />(City Code is available on the Internet: www.ci.roseville.mn.us). <br /> <br />SETBACK PERMIT APPLICATION <br />(CITY CODE SECTION 1013.05) <br /> <br />2f RESIDENTIAL PROPERTY OWNER FEE - $25 <br />(All fees payable upon submittal of completed application) <br /> <br />Please complete the application by typing or printing in ink. If the spaces provided are insufficient, use <br />additional sheets, keying information to the proper item numbers: <br /> <br />1. <br /> <br />Name of Owner: <br /> <br />(First) <br /> <br />(Middle) <br /> <br />(Last) <br /> <br />(Phone) <br /> <br />2. <br /> <br />:11 ~ fu,d i4.e.O::{-h 0- <br />Address of Owner: (No. And Street) <br /> <br />'H-cuu K\\I\ ~ <br />(State) <br /> <br />3. <br /> <br />(City) <br /> <br />II LiLl W .R~a .V\ .(4\1<- KCf;uJ t' lk <br />Name of Applicant: (First) (Middle) <br /> <br />=n'VY\ ill\J. .f.J -ccd-t'\Or '~kJ \\3 <br />Address of Applicant: (No. And Street) (City) <br /> <br />(\f\ f\J <br />(Last) <br /> <br />08- '-i ~R' - 'i?K'2Jlo <br />(Zip) <br />55113-5CJ9~ <br />(Phone) <br /> <br />4. <br /> <br />{05;/- Lt~)( - 8'K3lo <br />(State) (Zip) <br /> <br />5. <br /> <br />~ W. 1<.licU,A\I~ ~~;IL <br />Street Address of Prope~ty Involved: <br /> <br />.~f) f\J 55/13 -- 69 c9c <br /> <br />6. <br /> <br />illy L0. 1<fsa.tA- -Ave- Kos~udl~ VYlN 55113'~ E/jd'f; <br /> <br />State exactly what s intended to be done on or with the property that requires the setback <br />permit: <br /> <br /><see o.th;Ac.hcd <br /> <br />~h~c:J- <br /> <br />7. <br /> <br />Explain alternatives that have been examined which would enable you to meet existing Code <br />requirements: <br /> <br />8CC':- aJ-+ d.CJ\C'.J ~cd- <br /> <br />Page 1 of 3 <br />