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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 0-10 W I iv tO S Ai M M L 1Z (-AN <br /> PID: <br /> DESCRIPTION OF WORK: (Ns r w.‘ <br /> ZONING REVIEW BY: A f( DATE APPROVED: <br /> BUILDING REVIEW BY: / DATE APPROVED: z- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes No - SEWER CONNECTION <br /> STATE SURCHARGE Yes No WA 1'R CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: ✓`)O C 11i9A1G�P <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wedd: <br /> Building Height: Def. Hgt. Peak Igt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): F N„if(A,a a nr c c /;:&,3 . IA) elver-ell-4,2g- <br /> 7 <br /> ew7 <br />