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CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for which you are applying: <br />_ Rezoning $100 _ Division of Platted Lot $50 <br />Special Use Permit $100 Relocation of Dwelling $50 <br />— Vacation of Right-of-way $100 Variance to Zoning Ordinance $50 <br />Preliminary and Final Plat $100 _ Minor Variance $25 <br />Please complete form by typing or printing in ink. If the spaces provided <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: <br />Name of Owner: <br />2. <br />Ad <br />3.. <br />4. <br />ess of Owner: <br />Name of Applicant: <br />(First) (Middle <br />(No. and Street) <br />f^mot, <br />(First) (Midd <br />Aaaress of Applicant: <br />5. .2�1-1 -- ..2,6 0 <br />Street Address of Fern <br />le) <br />ptNNo. ana street <br />-ry-a( t, <br />(City) <br />(City) <br />R05e V Ilk <br />(Last) (Phone) <br />AY <br />(State) (Zip) <br />t P tips 7�� 37Y -1770 <br />;Last) (Phone) <br />Comp,.Qt6"Lega] Description q Property Involved: , <br />I <br />State) (Zip) <br />0 <br />7. Date P c uired• <br />8. Present Use of Property: <br />��.- . Proposed Use of Property: <br />9. Present Zoning of Property: _ — Proposed Zoning of Property: 10. What plan or/ changed jukes this r? quest necessary? 1`o e <br />�Q�u4s7�a t lrC�c�U� Q � f�.�t� . Z. 0� .ac,&. j: ,, <br />11. What is the expected effect of the proposed change? (For example, on <br />prop D ty value_sLF he�lth,o safety, parking, traffic conditions, etc.) <br />