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f , . <br /> . • <br /> CHECK OFF LIST FOR ISSUA��tCE OF PER11�iITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: (�,y 5 �=c-2N J,q t,� �� <br /> PID: <br /> DESCRIPTION OF WORK: �',4,�tq�P + Wt�v � (t.bvw� Y��D 0 t �►-"t,�� <br /> ZO.vI�Ii G REVIEW BY: DATE APPROVED: g • 2- o�-I <br /> BUILDI�IG REV��V BY: DATE APPROVED; � •�m y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1ti1IT Yes �/ No <br /> PLA��I REVIEW Yes ✓ No SEWE.R CONNEC'I'ION <br /> STATE SURCHARGE Yes �/ No WA'ITRC0�INECTION <br /> INVESTIGATION FEE Yes I�`o PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�II�G CH�CK LIST zoning District: <br /> Fire Departmen[: Post Office: Scbool District: <br /> Lot Area: Sq.ft. Acres Wid[h Depch <br /> Survey Submitted: Yes er No Date of Survey: S -��► �a`I <br /> Proposed Setbacks: � <br /> Froat (�ake}: �05 � Righ[Side: 5�0.� � N <br /> Rear (StFeet): IOOp� 'f' Left Side: I I U� <br /> Adjaceat Structures: — `Vetland: —' <br /> Building Hei�ht: Def. Hgt. c> .K- Peal:Hgt. <br /> Lot Coverage: /� �/� <br /> Grading: Staff Approval Date: -- By: Council Approval Date: <br /> Sep[ic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: � Resolutioa Date: <br /> Shoreland Dis[rict: ►'�I� <br /> Avg. Se[back: Bluff Setback: Lot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-5Q0' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REIVZARKS (in house): <br /> 7 <br />