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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: �04S �2�,� (�,�.q,/, <br /> PID: <br /> DESCRIPTION OF WORK: Q���c ,/��,p ,rt a.� <br /> ZOY.ni IG REV�`V BY: DAT'E APPROVED: F3 •Z 3-a y <br /> BUII.D .ri 1G REVIE`V BY: DATE APPROVED: S3 -Z3•o y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1tiITT Yes �/ No <br /> PLA��t REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No WATE.RCONNECTION <br /> ����E-INVESTIGATION FEE Yes r/ No PARK FEE <br /> � SAC Yes No ✓ SITEINSPECTION <br /> �� Number of SAC�Units OTHER (specify) <br /> Z01�1I�tG CHE.CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Wid[h Dep[h <br /> Survey Submitced: Yes �C No Date of Survey: 1 Z-�v ��2 <br /> Proposed Se[backs: <br /> Front(L'�e): 1 9S Right Side: "17 � <br /> � � <br /> Rear (S�eet): � � Left Side: �O' <br /> Adjacen[ Structures: �hh�`t�4c.tt-�� `Vetland: n/ �ya <br /> Building Heighr. Def. Hgt. — Peak Hgt. —" <br /> Lot Coveraoe: — <br /> Grading: Staff Approval Date: -- By: Council Approval Date: <br /> Sepcic: Staff Approval Date: � By: <br /> Zoning File: # � Resolution: � Resolutioa Date: <br /> Shoreland District: � <br /> Avg. Setback: Bluff Se[back: L.ocCovera�e: <br /> Eusting 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): � W02K S�,�Zn_.� W/d �Pc;R� T <br /> 7 <br />