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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 <br />$100 <br />_ Division of Platted Lot <br />$50 <br />Special Use Permit <br />$100 <br />Relocation of Dwelling <br />$50 <br />_ Vacation of Right -of -Way <br />$100 <br />Variance to Zoning Ord-nance <br />$50 <br />Preliminary and Final Plat <br />$100 <br />Minor Variance <br />$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 />Name of Owner: <br />2. 143s <br />Address of Owner: <br />3. <br />4: <br />5. <br />1A <br />(First <br />�2IMHIN5 <br />! (Middle <br />Yd n7 AVE, W. T <br />(No. and Street <br />1=VILLE <br />✓El2500 6 4-6-6 71 <br />(Last) (Phone <br />(City) <br />5-r6116rj IZOLA00 $autj(2 <br />Name of Applicant: (First) (Middle) <br />(State) <br />(Last) <br />.11 3 <br />Zip) <br />46 4- 31 g 6 <br />(Phone) <br />13(�<,Q <br />JEW6L LAN6� 00. <br />F�R1��5T �4r;c atnl <br />S s�z��' <br />tress of Applicant: <br />(No. and Street) <br />(City) (State) <br />(Zip) <br />2-087 AUe, N,O F,0Se•l'iL4-G-4 Mrs• 5-5.113 <br />Street Address of Property Involved: <br />6. Complete <br />Legal <br />Description <br />of Property <br />Involved: <br />Kt:- Af:6404Et7 <br />r:Z')— 1NVIDz.yge�D 14 PTV O, <br />7. Date Property Acquired: Li=-ASc' <br />8. Present Use of Property: ���;�v,�tiNr'S Proposed Use of Property: ycs�,���,�,,f <br />9. Present Zoning of Property: _(3� Proposed Zoning of Property: 6-3 <br />10. What plan or <br />change <br />makes <br />this <br />request necessary <br />7c� <br />Lc: Tie,Q <br />O r <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />