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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: Z5`�(t� 5 � x t-r4 t1 v� . <br /> PID: <br /> DESCRIPTION OF WORK: S <br /> ZO.�tI�ti G REY�W BY: DATE APPROVED: J�- I Z-g� <br /> BUILD�TG REVIEW BY: � DATE APPROYED; �1 —��ti �S�, <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERNIIT Yes ✓ No <br /> PLAN REVIEW Yes v- No SEWIIt COrfNECTION <br /> STATE SURCHARGE Yes �.-- No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZON7NG CH�CS LIST Zoning District: R2•1� .. <br /> Fire Department: (�•��-t� Post Office: .v l�1�.�3 School District: O•�r.�.Wa <br /> ✓ <br /> Lot Area: Sq.ft. /�'�+ GNTn�r�Acres � Width Depth <br /> Survey Submitted: Yes K- No Date of Survey: y S <br /> Proposed Setbacks: � <br /> ► <br /> Front(Lake): � Right Side: �S� � <br /> Rear(Street): ?v� Left Side: �l�S� <br /> Adjacent Structures: 7io Wedand: /`f �� <br /> Buildin;Height: Def. Hgt. �,�L Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Sepdc: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resoludon Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff tback: L.ot Coverage: <br /> � Exist' Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />