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• <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 <br />Special Use Permit $100 <br />Vacation of Right -of -Way $100 <br />Preliminary and Final Plat $100 <br />.._ Division -if Platted Lot $50 <br />_ Relc .-ation of Dwelling $50 <br />Variance to Zoning Ordinance $50 <br />_ 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 />1. <br />2. <br />3. <br />4. <br />5. <br />Name of-ewnetr-r (First) (Middle) (Last) (Phone) <br />i2-2d b N� ' <br />5 <br />Address of ^ ,„^r: (N4. and <br />A ffit [.rw_'� <br />Street) <br />( City) (S'ate ) (zip) <br />L �� <br />tt <br />Doo �a`� <br />?i <br />Name of Applicant: (First) <br />(middle) <br />(Last) <br />(Phone) <br />k2- S <br />Aci�s' <br />R-ose,��,1�� <br />Ion ;"s I I �_ <br />Address of Applicant: (No. <br />and Street) <br />( City) <br />_ <br />(State) (Zip) <br />�rJ (,jrJIMf%CK3ir{; +Poe 0r,� OF ���xjo:� -��;. _..,., , ;,>,,-::_ <br />r- ,,� �� >i <br />A,)1b 00PTI-` C4 JILL'Ow <br />Street Address of Property Involved: <br />6. Complete Legal Description of Propert I voly d: <br />L <br />e� P <br />T. Date Property Acquired: <br />8: Present Use of Property: Proposed Use of Property: <br />9 Present Zoning of Property: Proposed Zoning of Property: <br />1-0 What plan or change makes this request necessary? <br />11,E what is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />