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CHECK OFF LIST FOR ISSUANCE OF PERNUTS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 5 ey/Wo w 8 r iy _ ,Y0 J A S g3 C? <br /> PID: oy - 117-z3 1 y 0D03 <br /> -DESCRIPTION OF WORK: <br /> Z01rLNG REVIEW BY: c DATE APPROVED: (P z.7 T,1 9 <br /> BUILD7NG REYIEti BY: . DATE APPROVED: •2 g :�t 1 <br /> TEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT -Yes t�-- No <br /> PLAN REVIEW Yes I/ No SEWER CONNECTION <br /> STATE SURC_HARGE Yes 4/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No J SITEINSPECTION <br /> Number of SAC Units . .OTHER (specify) <br /> ZONING CBECK LIST zoning District: R R- I 13 <br /> Fire Department: L L Post Office: Z olo, School District: -2 79 <br /> Lot Aiea: <br /> S .f. Acres � Q � Width � Z � ' -5- Depth _72 <br /> Survey Submitted: Yes, No Date of Survey: 2- <br /> Proposed <br /> Proposed Setbacks: p) <br /> $T -- <br /> -_:Front(Like): , =� Right Side = q - ----- — <br /> Rear(Street): 2 g J Left Side: <br /> l <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hat. 2 3 ` E , Peak Hgt. -2.3,5 - <br /> Lot Coverage: /1J A <br /> Grading: Staff Approval Date: •-- By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # ' Resolution:# Resolution Date: <br /> Shoreland Dist.-ict: _ <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> N <br /> 75-250' <br /> 250-500' . <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REiyIARKS (in house): <br /> �:,; .26 <br />