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� � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 477 5 �'°�-r s�� <br /> PID: <br /> DESCRIPTION OF WORK: (�0 2cc-� <br /> ZO�tING REVIEW BY: DATE APPROVED: �-3-z�v3 <br /> BUILDING REV�W BY: DATE APPROVED: 3-�-s —�3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> pLAN REVIEW Yes , No � SEWER CONNECTTON <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOti1'�1i G CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.fr. Acres Width Depth <br /> Survey Submitted: Yes ,� No Date of Survey: o�' f=►t� <br /> Proposed Setbacks: <br /> Front (Laic�: 1��1 Righ[Side: SZ�� <br /> Rear (�: �� Left Side: i bo� <br /> Adjacent Structures: �� � Wetland: <br /> Buildin� HeiQht: Def. Hgt. ��/'� Peal:Hgt. " <br /> Lot Covera�e: N L/�- <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zonin� File: # � Resolution: # Resolution Date: <br /> Shoreland District: �� <br /> Av�. Setback: Bluff Setback: Lo[Coverage: <br /> ExistinQ Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da[e of Council Approval: <br /> RE�IARKS (in house)• <br /> 7 <br />