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CHECK OFF LIST FOR ISSUAl�tCE OF PERi1�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 17 9 S d'fr� �a ,O <br /> PID: <br /> DESCRIPTION OF WORK: ��uC <br /> ZO,�i'G REV�`V BY: DATE APPROVED: 7• Z.Y-�o <br /> BUILDPtG REVIEtiV BY: DATE APPROVED; 7. Z y -�v <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �.i' No � <br /> PLAN REVIEW Yes v No SEOVER CONNECI'ION <br /> STATE SURCHARGE Yes � No WATER CONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Un.its OTHER (specify) <br /> ZO�G CH�CK LIST Zoning District: M' ct-r�an�..�o <br /> Fire Department: Post OfFice: School Disuict: <br /> Lot Area: Sq.ft. Acres W dth Depth <br /> Survey Submitted: Yes � No Date of Survey: �on.� <br /> Proposed Setbacks: � <br /> Fron[(L-ai�e): (�$� Right Side: <br /> Rear(St�eei�: � �O Left Side: <br /> Adjacent Structures: _ �-7Ty�c�/./-e� Wetland: �'7n ' . <br /> Building Hei�ht: Def. H�t. 0.(<- Peak Hgt. -- <br /> Lot Covera�e: -- <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Sep[ic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> 0��� <br /> Shoreland District: <br /> O� �.' Avg. Setback: Bluff Setback: I.ot Covera�e: <br /> �.1• Existing 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 /> RE�IARKS (in house): _ <br /> 7 <br />