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w 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 />— Special Use <br />Permit <br />$100 _ <br />$100 <br />Division of Platted Lot- <br />$50 <br />___. Vacation of <br />Preliminary <br />Right -of -Way <br />$100 _ <br />Relocation of Dwelling $50 <br />Variance to Zoning Ordinance $50 <br />_ <br />and Final Plat <br />$100 <br />Minor Variance <br />$25 <br />Please complete <br />are insufficient, <br />form by typing or printing in ink. If the spaces <br />use additional sheets, keying information to <br />ded <br />item numbers: <br />thep <br />proper <br />roper <br />1. 1,�A(_R <br />ate- <br />2. <br />3. <br />u N &J (0 y5 - 27t ; <br />`e ( La��%s�/t ) ( Phone <br />I ( <br />"'U� <br />4 <br />(City) (state) <br />lvdme or Applicant: F' <br />( irst) (Middle) (Last <br />4. (z Lk <br />Address of A <br />5. <br />6. <br />Name of Owner: <br />Address of <br />First) <br />(Middle) <br />r: (No. and Street) <br />ppl ant: (No. and Street) (City) <br />N� v <br />Street PA,,d�dpr sn)of Property Involved: <br />Comple4'4° a7 - Description of Pro Igg' <br />7 perty involved; <br />13 / 1/�_ <br />4 <br />667I,P <br />(Zip) <br />7a-7 <br />(Phone) <br />(State) (Zip) <br />7. Date Property Acquired: o <br />8. Present Use of Property: Proposed Use of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />c- _ <br />