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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: y2�5 GH � PPEwA C,A�� � <br /> PID: - -- -- <br /> DESCRIPTION OF WORK: �—uv�vrs Go��- <br /> ZO�P1G REV��V BY: /�� ��------ DATE APPROVED: � - / �03 <br /> BUILDI�i IG <br /> REV�`� BY:���� — DATE APPROVED: � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER11i1IT Yes ,/ No <br /> PLAlv REVIEW Yes � No SEWER CONNEG"ITO�' <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO��tG CH�CK LIST zoning District: .. <br /> Fire Deparcment: Post Office: School District: - <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes � No Date of Survey: o� F� �. <br /> Proposed Setbacks: <br /> Front(Lake): Z�� � Righ[Side: .5�` � <br /> Rear (Street): Z��` �= Left Side: 2 2S <br /> Adjacent Structures: 1 Oc�` �Vetland: -- <br /> Building Hei;ht: Def. Hgt. r Peal:Hgt. — <br /> I.ot Covera?e: — <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Sep�ic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland Districr. N� <br /> Avg. Se[back: Bluff Setback: L,ot Covera�e: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council App:oval: <br /> REI�LA.RKS (in house): <br /> 7 <br />