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� CHEC�i OFF LIST FOR ISSUA.��rCE OF PER�tiTITS <br /> _ FOR OFFICE USE ONLY � . <br /> ADDRESS OR LEGAL: ��o C�x �A-��- �� <br /> PID: <br /> DES CRIPTION OF�ORK: �=r�,�s�r �rn� s�1 A � �� ���cb0 <br /> , � <br /> ZOti'Lti�G REY�ti�BY: �1 �� D�iTE APPRO��D: <br /> BUILDI�'G REVIE'6V BY: D�TE APPROVF•D: �- Z -c�l . <br /> FEES TO BE CH.4RGED: Niisc. Fees Calculated By: <br /> pERMIT Yes _ � No : <br /> PLAN REVIE�1 Yes _� No SE�CO: :'ECI'ION <br /> STATE SURCHARGE Yes � No `�ATERCOi�Iti�CTION <br /> II�'VESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (speciy) <br /> ZO\�L�iG CZ-i�CK LIST zanin�Districr.�U <br /> Fire Depar[ment: Post Office: School District: � � <br /> I.ot Area: Sq.fc. Acres Width Depth <br /> Survey Sub.Litted: Yes No Date of Survey: <br /> Proposed Setoacks: <br /> F:oa[ (La.ke): R.i;hc Side: � <br /> Rear (Screet): Left Side: <br /> Adjacenc Struccures: �Vet and: � <br /> Buildin� Hei�hc: DeE. H�t. Peak H�t. <br /> Lo� Covera�e: <br /> Gradin�: Stafi Approval Date: By Council Appro��a! Date: <br /> Septic: Staff Approval Dace: By <br /> Zoning File: n Resolution: : Resolutioa Date: . <br /> Shoreland District: <br /> Av�. Setback: Blufi Setback: LOCCO"`a=" <br /> Eacisim� ProFosed <br /> Hardcover: 0-7�' ---- <br /> 7�-250' <br /> ti0-500' <br /> Sd0-1000' — <br /> Hardcover Variance Required: Yes No Dat� of Co�ci? Aoproval: <br /> REI�LAR�iS (in house): <br /> 7 <br />