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� � CHECb OFF LIST FOR ISSUA.i�'CE OF PERitinTS <br /> : FOR OFFI�E USE ONI.Y . ' . <br /> ADDRESS OR LEGAL: -�so v 5 H-tN,��t,,��o/� (1-e+o� <br /> PID: <br /> DESCRIPTION OF ti'VORS: (Zi��upu �= <br /> . <br /> ZOr�G REVIEti�BY: IU ( I� DATE APPROV�D: <br /> BUII..DING RE'YIE�BY: . DATE APPROYF�: 3- Z`� = t�( <br /> FEES TO BE CH.4RGED: hiisc. Fees Calculated By: <br /> PERNIIT Yes ✓ Pdo :• <br /> PLAN REVIEW Yes I�10 ✓' SEWER COYNECTION <br /> STATE SURCHARGE Yes J I�To WATERCONNEC'ITON <br /> IIv'VESTIGATION FEE Yes No pARK FEE <br /> SAC Yes �10 SITEINSPECIION <br /> Number of SAC�Units ' OTHER (specify) <br /> � — <br /> ZO��L�tG CH�CK LIST zoni.ng Dis�icc: /�V C� . <br /> Fire Department: Post Office: School District: • � • <br /> Lot Area: Sq.ft. Acres � idth Dcpth <br /> Survey Subritted: Yes No Date of Survey: <br /> Proposed Setb2cks: <br /> F.oat(La.ke): Right Si�e: <br /> Rear(Screet): Left Side: <br /> Adjaceat Structures: I tiVetl d: • <br /> Buil�in�Height: Def. H�t. Peak gt. <br /> Lot Covera�e: � <br /> Grading: Scafi Approval Date: By Council Approval Date: _ <br /> Septic: Staff Approval Date: By <br /> Zoaing File: � Resolution: : Resolution Date: • <br /> Shoreland District: <br /> Av�. Setback: Blufi ecback LocCocera�e: <br /> E�� � proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> ti0-500' <br /> 500-1000' -- <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> gEI�IARhS (in house): <br /> �, <br />