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City of <br />`� <br />� Minnesota <br />H4USING AND REDEVELOPMENT AUTHOI�TY <br />Roseville Housing Redes�gn Program <br />SELECTION QUESTIONNAIRE <br />This questionnaire will be used in selecting, on a iirst-come-%rst-serv�ice basis, homes far the Roseville <br />Housing Redesign Program. Return this Forrr�. ta: <br />The Roseviile Housing a;td Redevelopment A�thority <br />2660 Civic Center �rive <br />Roseville, MN 55113 <br />At a minimum, please include two snapshots of your home, showing a£�!i exterior view of: 1.) the front, <br />and 2.) the back of yaur home. You may also 1'rke to include the interior views of your home where <br />improvements are going to be made. In addition, any site and/or sketch plaris prepared showing how the <br />improvements will change the existing Yiame floor plan. If available, elevations showing €he view fram <br />th.e street. are preferred. <br />If you have questions and need assistance completing tl�e appiication, please call the HRA Hotline at b5i- <br />7g2-7�015. <br />Please complete e fallowing info tio � �`\� <br />Yonr Name(s): � ����� � <br />House Address: <br />�ome phone: "- <br />Emaii address: �v ' <br />How long have you li�ed in the hame: C� <br />House Type: {eg.. Rarnbler, Story &'/z ( <br />Stor}�, $ungalaw, Color►ial erc.) <br />1,�C�L 0 �� �---- �L�� <br />Work Phone(s): � � `r--- �� �� <br />� CC En� ' �- �1 i D� <br />� <br />:. Cod), Twa story,. Tuck �nder,. alk u lit Le�e Two <br />Ye�r Built {estin te) � _ Finished square feet: �� �O <br />Lot size: "!�� 1�� (eg. 50' x 10Q') Existing Assesses Value ��,�� I � <br />Number nf People in Household: �Ytildren under rhe age of 16: � <br /># of Bedrooms: � # of $athrooms: � <br />Farnily room? ' S �f so, on what level? ��� � ���-� <br />Describe the garage (eg, # of stalls, atCached/detached, none) <br />, .� °� ---' �- ��� �� <br />What, if ariy, major improvements ha�e already been �nade to yciur home? °��/���``-��Q�� �"���� <br />'�,L� i� � � (�> Y�S\�, �i�'(�� � � � �'�,.s ��(�'`L-- <br />Check the i�nprovements you pl�n on n�aking ta yoar �onie wit this appfieation. "'' ��'�'' �'�'�e ��"'�`�"� <br />enlarged and improved kitchen �additianat enlarge �iathroom �'�/`� <br />�add a master bedFOOrn/cou le's adc� a s.econ s o�� � � <br />creation of"N- ainain floor farnily room add a second garage stall <br />attaeh a detached arage �add a new fron,t e try <br />C�'��u., `�'����� . ��-`�C� ��.�.��G'��� � �, ��,�.np <br />� �, <br />���� �,%�i�`%Y� �,��-i,�.v� vye.�� <br />���`� �b�� � � L�x�� � � ` �` `�'� <br />