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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ' ADDRESS OR LEGAL: �Z�C� S�-4►��Do�s v o,� D2 . <br /> PID: <br /> DESCRIPTION OF WORK: _��-i- ��,,q,R,¢��s <br /> ZO�tG REv�W BY: DATE APPROVED: 6 -�o- oy <br /> BUII�DI�i 1G REV�`i� BY: DAT'E APPROVED; �,-t c�-o y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/ No <br /> PL?,i�T REVIEW Yes �/' No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes —� No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SIT'EINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CK LIST Zoning District: . <br /> Fire Departmen[: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres � Widch Depth <br /> Survey Submitted: Yes r/ No Date of Survey: n�+ f-�u� <br /> Proposed Setbacks: � <br /> Front(�ee): I I l�' � Right Side: �133 � <br /> Reaz(�t�ee�t): � � U Left Side: `� 7 � � <br /> Adjacent Structures: (`i� �Vetland: <br /> Building Height: Def. Hgt. �5� Peak Hgt. ?�' <br /> Lot Coveraoe: G ��- <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # '— Resolution: fl Resvlution Date: <br /> Shoreland District: �J <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezistin; Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />