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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I 2 4'� C N C v�/ C��-/�5 c: <br /> PID: <br /> DESCRIP'I'ION OF WORK: �q,p,p„-�v...�� /��=`yioDP c. <br /> -, <br /> ZOr1NG REVIE�V BY: DATE APPROVED: -T- Z�1 - 0 5 <br /> BUILDING REVIEW BY: DATE APPROVED: �• z�- a S <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 WATER CONNECTTON <br /> �INVESTIGATION FEE���'��'es r/ No PARK FEE <br /> SAC Yes No ,/ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZO��G CI�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes oC No Date of Survey: (0- I - `j'�( <br /> Proposed Setbacks: <br /> Fron[ �a�e): 3�' Right Side: )00� <br /> � <br /> Rear (St�cct): I 2 3 Left Side: �{b <br /> Adjacent Struccures: /t!//� Wetland: N �� <br /> Building Hei�ht: Def. Hgt. p.k Peak Hgt. <br /> Lot Covera�e: c9.k-- <br /> Grading: Staff Approval Date: ^/�/a By: Council Approval Date: <br /> Septic: Staff Approval Date: n/�/� By: <br /> Zonin� File: # — Resolution: # Resolution Date: <br /> Shoreland District: /V� <br /> Av�. Setback: Bluff Setback: L,ot Coverage: <br /> Existin� Proposed <br /> Hardcover: 0-75' <br /> 7�-2�0' <br /> 2�0-500' <br /> 500-100�' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> � REl�L4RKS (in house): c�J O tZ 1� �T,/�l�-�'L',� �,.� ��t�-�� � ��('� +'— <br />