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<br /> <br />2660 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 />R5 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 /> <br />(City) <br /> <br />(State) <br /> <br />(Zip) <br /> <br />2. <br /> <br />Address of Owner: (No. And Street) <br /> <br /> <br />(Middle) <br /> <br />(Last) <br /> <br />(Phone) <br /> <br />3. <br /> <br />Name of Applicant: (First) <br /> <br /> <br />4. <br /> <br />Address of Applicant: (lifo. And Street) <br /> <br />(City) <br /> <br />(State) <br /> <br />(Zip) <br /> <br /> <br />5. <br /> <br />11fc E LJfPrJ E CT~ <br />6. State exactly what is intended to be done on or with the property that requires the setback <br />permit: <br /> <br /> <br /> <br /> <br /> <br />7. Explain alternatives that have been examined which would enable you to meet existing Code <br />requirements: <br /> <br /> <br />Page 1 of 3 <br />