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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � � �c2nr��i,�; �.,(�,�,-� <br /> PID: <br /> DESCRIPTION OF WORK: d� ` <br /> ZO.VI�Ii G REV�`V BY: DATE APPROVED: � - S vy <br /> BUII.,DIVG REVIE`V BY: DATE APPROVED: � -S-_�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERI�IIT Yes t/� No <br /> PLAl�t REVIEW Yes � No SEWF.R CONNECITON <br /> STATE SURCHARGE Yes No WAT�ERCONIVECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�II�1G CHE.CK LIST Zoning District: <br /> Fire Department: Post O�ce: School District: <br /> L,ot flrea: Sq,ft. Acres Widch Dep[h <br /> Survey Submitted: Yes�[ _ No Date of Survey: bns t=1 c� <br /> Proposed Setbacks: <br /> �roat(�s): ((�a � � Right Side: '�0 1 t <br /> Rear (Si�eet): _ �� 'L Lef[Side: �(�v' "� <br /> Adjacent Structures: (0 � �Vetland: �f � A <br /> Building Hei;ht: Def. Hgt. — Peak Hgt. �- <br /> Lo[ Coverage: � <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Sep[ic: Staff Approval Date: — By: <br /> Zoning File: # � Resolution: t� Resolutioa Date: <br /> Shoreland District: /J v <br /> Avg. Setback: Bluff Setback: L.otCovenge: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-SQO' <br /> 500-100Q' <br /> Hardcover Variaace Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />