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i <br />A <br />M <br />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 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 <br />$25 <br />Please complete form by typing or printing in ink. If the spaces <br />are insufficient, use additional sheets, keying information to the <br />item numbers: proper <br />1. <br />Name of Owner : ( F ' rst ) <br />(Middle) (Last) (Phone) <br />2 . v (CA V1 M N <br />Address of OAy wner: (No. and Street) <br />(City) (State) (Zip) <br />3° IG <br />Name of Applicant: (First) (Middle) <br />(Last) _(Phone) <br />4 . Xj^3 O ✓1 C.Qi i�i1 h� I.t.Pi <br />Address o Applicant: (� <br />(No. and Street) (City) (State) (Zip) <br />5. 2 l� <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />7. Date Property Acquired: <br />8. Present Use of Property: WQproposed Use of property: <br />9. Present Zoning of Property: -_Pro osed Zoning of Property: <br />10. What plan or change makes this request necessary? (. <br />O 0, <br />11. What is the expected effect of the proposed change? <br />property values, health safety,g (For example, on <br />parking, traffic conditions, etc.) <br />