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, CHEC3K OFF i�IST FOR iSSUANCE OF �'ERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I Z s0 S P 21J c�. ���� <br /> PID: <br /> DESCRIP'I70�T OF WORK: I'2��C3 v+��D �X �s�n1< �c�-yc � (U3�P tA c..�� <br /> -- ---_-- ---------------------------------------------------------- <br /> ZOV .Ti IG REVIE`V BY: � ww� w DATE APPROVED: Y- /2-�6 <br /> BUII�DING REVIE�Y BY: DATE APPROVED; Y.�2 .ose . . <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIE`V �� Yes �/ No SEWER CO�tNEC'ITON <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No ./� PARK FEE <br /> SAC Yes No c� SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOtY�.��TG CHE.CK LIST Zoning District: �!'� C �-f�4N� . <br /> Fire Department: Post O�ce: _ School District: � � <br /> Lot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: . . <br /> Froat(Lake)• Righ ide: <br /> Rear(Street): Left Side: � <br /> Adjacent Struchues: Wetlan : <br /> Buildin'Heighc: Def. Hgt. Peak gt. <br /> Lot Coveraae: <br /> Grading: Staff Approval Date: y: Couacil Approval Date: ' <br /> Sepcic: Staff Approval Date: By: <br /> Zonin; File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Se back: L.ot Coverage: <br /> Existi.nQ Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250` <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da�e of Council Approval: <br /> REI�LARKS (in house): LX�4c� i�%�GQ C-�'�"'''''� o � c:� �S n�v�► f-�� <br /> � <br />