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. �CHECK OFF LIST FOR ISSUANCE OF PERl�IITS <br /> FOR OFFICE USE ONLY - <br /> ADDRESS OR LEGAL: �Zv U2-��g 7�a-•. G�.'�t� <br /> PID: <br /> DESCRIPTiON OF WORK: (� L w iZc� <br /> ZO�'G REV��V BY: DATE APPROVED: I i - 3�•�r� <br /> BUII1DlvG REVIE`V BY: DATE APPROVED; ►c • 3� �S�+ <br /> FEES TO BE CHARGED: / Misc. Fees Calculated By: <br /> PERMIT Yes �� No <br /> pLAN FtEV�W Yes � No SEtiVER CO�TNECTION <br /> STATE SURCHARGE Yes� No �IATERCOiVNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPEC'TION <br /> Number of SAC�Units OTHER (specify) <br /> ZO`Z�G CH�CK LIST zoning Districc: <br /> Fire Department: �., �u.v Post O�ce: f School District: �D �N'� — <br /> Lot Area: Sq.ft. I l 1,1 Dv Acres Z� 5'� Width ��1].��� Depch <br /> Survey Submitted: Yes ,.L No Date of Survey: 1 1 - ��'l -�i Z <br /> Proposed Setbacks: � <br /> Front (L-�ke): ��- Righ[Side: � �S <br /> Rear (Sueetj: I '0v Left Side: 37 � <br /> Adjacent Structures: � (� Wetland: ti � � <br /> Building Hei�hr. Def. Hgt. � Z 9 • S Pea�:Hgt. ,3�J <br /> Lot Covera�e: N �v4- � <br /> Gradin�: Staff Approval Date: ( � - LG --� °l gy; �_ Council Approval Date: � _ <br /> Sepcic: Staff Approval Date: 12`I- `� `( BY� �i�'} <br /> Zonin� File: # � Resolution: # �' Resolution Date: � <br /> Shoreland District: �C9 <br /> Av�. Setback: Bluff Setback: L,otCo��era�e: <br /> Ezistin; Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-Sa0' <br /> 5Q0-1000' <br /> Hardcover Variance Required: Yes No Da[e of Council Approval: <br /> RE��IARKS (in house): <br /> 7 <br />