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I <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for which <br />ch YOU are applying; <br />Special Use Permit $100 Division of <br />Vacation of $100 _ Relocation of Platted <br />Lot <br />—. Preliminary Right- 100 $50 <br />and Final Plat Variance to Dwelling $50 <br />Please Complete $100 � Minor Variance Ordinance $50 <br />are insufficient <br />by typing $25 <br />. use additional in ink. <br />item numbers: s, keyin If the <br />9 Information to per 1, (� _ � Proper <br />Name - - Q <br />of a+►ner: (First) <br />2. � �,�, (Middle) 2_ 2,S t1 <br />(Last) (Phone) <br />Address 5 � � L � Q,v �' � e <br />of Owner: (No. and Street�To 1� <br />3. Apr ( City �s 11 <br />Nameo f(State) <br />® (Zips) <br />Applicant: (First) <br />4. 3eO !Middle) ?� 3 <br />�A _ Ave. . � (Last) <br />.. t Phone ) <br />Address of Applicant: �c EC y$4,ci /1,� N <br />tNo. and Street) � 5 & <br />,, Y ) <br />• /—�� ��...., tCit (State) (Zip) <br />S t ree t ,1, j <br />Address of Property Involved: <br />6. Complete Legal Description o <br />f proper! <br />3 Involved: <br />7• Date Proper! 1.3 J, <br />Y Acquired; � <br />8. Present Use of Property: <br />= Uatl . 1 Proposed Use <br />9. Present Bonin of Property: <br />9 of Property: y�'__ j Y'C��� �. <br />10 • What °-�---..._ Proposed Zoning of <br />Plan or change Property; <br />9 makes this request q' � � necessary? Ac�r r Y <br />11. what is the ex <br />roper! Peeted effect of the <br />Y values, health Y, proposed chap <br />n 4y safe! parking. traffice? (For example, on <br />conditions <br />— etc.) <br />