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� � CHECK OFF LIST FOR XSSUANCE OF PER�I�IZTS <br /> � FOR OFFICE USE ONLY <br /> ADDR.ESS OR LEGAL: _ "1 g� Fc2N��4c,,E R.o,.,,�J I�I OR.'rtf � <br /> PID: _ .31.� ��b �� �� -�� 3 <br /> DESCRIP�'ION OF WORK: N�t � 2�� <br /> ------------------------------------------------ <br /> ZO�G REVIEti�BY: � ,,,,, DATE APPROVED: �3, 3-�g---- <br /> BITII�DPi 1G REVIE�'V BY: DATE APPROVED: g.-3-Q� <br /> . ---------------------------------=- <br /> �EES TO BE CHARGED: - Misc. Fees Calculated By: <br /> PERNIIT Yes i/' No ' � <br /> PLAN REV�W Yes �/ No SEW�CONNECTION ' <br /> STATE SUR`H�Gr Yes �/ No WATER CO�INECTTON <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------- ----- <br /> �0�1ING CHECK L' IST zoning District: Q(�,- �g <br /> Fire Department: �„JpN,,�,q�p Post Office: S,,tQ��� School District: Wq.{-�--� <br /> Lot Area: Sq.ft._ �'7,1?v�i' Acres Z.Oc� tiVidth Z3j.o1 � Depth 3S 7.S'� <br /> Survey Submitted: Yes�_ No Date of Survey: _ 7-[(�-Y(o <br /> Proposed Setbacks: I <br /> Front (La.tie): . 2J0 Right Side: $b.� � I <br /> Rear (Street): I o 5 Left Side: kb.3 <br /> � <br /> Adjacent Struc[ures: N�I� �Vetland: A1(� ; <br /> Building Height: Def. Hgt. 2�i Peak Hgt. 3S� <br /> Lot Coverage• _ �//R' <br /> Gradin�: Staff A roval Date: �' 3� �Y� �0- � I <br /> � PP By: Council Approval Date: N��4 <br /> Septic; Staff Approval Date: _ Q -3- 9� By• S•�• <br /> . I <br /> Zonino File; � Resolution: # Resolution Date: � I <br /> Shoreland Dis�ict: � � <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> � Existin� Proposed � ' <br /> r(� � Hardcover: 0-75' <br /> 75-250' . - � <br /> 250-500' . <br /> 500-1000' <br /> . Hardcover Variance Required: Yes No Date of Council Approval: <br /> � <br /> RE��LA�2KS (in house): <br /> � . . � <br /> , ' Z� ,26 . <br />