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i . <br /> - : CHECK OFF LIST FOR ISSU CE OF PERII�IITS <br /> _ FOR OFFICE USE NLY , � . <br /> ADDRESS ORLEGA�..: Z�3 c� s N���-�+� �Q <br /> PID: <br /> DESCRZP'IZON OF WORK: 4(J t T� N ' <br /> . <br /> ZOi�i'G RE'����Y: DATE APPROYED: /�-Z�c�� <br /> BLTII,DIYG REVIE�Y BY: � j . D4TE APPROYID; /I� z--�� <br /> FEES TO BE CHAR�GED: Misc. Fees Calculated By: <br /> pERMIT Yes ,/ No :� <br /> pI,AN REVIEW Yes ✓ No SEWER CO�INEG"TION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION F�E Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC•U�its OTHER (specify) , <br /> ZO`Z�IG CH�CK LTST zonin;Districc: 2t2-\ _ <br /> Fire Department: 1c.� Post Office: rv C,� School District: n f2.O�v u� • <br /> Lot Area: Sq.fr. �� C M�i4N6 C Acrts � Width Depth <br /> Survey Subr�itted: Yes pC No Dat of Survey: oLT 21 , �uo <br /> Proposed Setbacks: r <br /> Front(�s.�: (,-� ' -�" Right Side: � �� + <br /> Rear(Street): 2`-1 2� �' Left Side: � � �- <br /> Adjacent Strucm�es: _/U�!9- Wedand: �--- • <br /> Builc�in� Height: Def. Hgt. c�•(L Peal:Hgt. ' —' <br /> L.at Covera�e: C��1� ' <br /> Grading: Staff Approval Date: ^ By: _,� Council Approval Date: <br /> Septir. Staff Approval Date: � By: <br /> � <br /> Zoain;File: � — _ Resolution: � Re�olutioa Date: . <br /> Shoreland District: /�� ' <br /> Av;. Setback: Blufi Setback: LotCovera�e: <br /> E���a , Proposed <br /> Hardcover: 0-75' ----- . <br /> 75-250' � — <br /> 250-500' - <br /> � 500-1000' <br /> Hazdcover Van'iance Required: Yes No Date of Council Approval: <br /> gEI�LARKS (in houSe}: <br /> � i <br /> � I — <br />