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CHECb: OFF LIST FOR LSSU��iCE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> �DDRESS OR LEGAI.: ��Z= �/Y P�''� _ <br /> PID: K,,1�,f� �oI <br /> DESCRIPT'ION OF WORK: �-►L- /+�"� <br /> �� ,� DATE APPROVID: <br /> ZO�G REVIEW BY: � DATE APPROVID: <br /> BL"II.,DING RE'VIE�V BY: ��-- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER'�2IT Yes ✓ No <br /> PI�'�t REVIE�' Yes �i No SEWER CONNECTION <br /> WATER COivNECTION <br /> STATE SL`RCHARGE 1'eS �� No pARK FEE <br /> INVESTIGATION FEE Z'eS No STTE INSPECTION <br /> SAC Yes <br /> Number of SAC Units _ OTHER (specify) <br /> ZONING CHECK LIST Zoning Discrict: <br /> Shoreland District : <br /> Post O�e: S ool D',d`strict: <br /> Fire Department: � <br /> Lot Area: Sq.ft. - Acres <br /> �._ , Wi Depth <br /> Survey Submitted: Yes r_ No Date of Survey: ��n, �t�. `�'�(�'�il� <br /> Proposed Setbacks: <br /> Front (Ia��). N �A Right Side: t O� `�� <br /> Rear (St�eet): 1`�l�' ± Left Side: 1 C�' N i..•� <br /> Adjacent Struccures: p4?"-�C-t��� We��d: I��!f7 <br /> Buildin� Height: Def. Hgt. Peak H�. <br /> Av�. Setback: <br /> Bluff Setback: L.ot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' Z3 '10 � F'.�v� 1�-e..e.c �,.,�Qvc�Q �n' G/+1,�-S <br /> 250-500' %-� �„� QPP.- <br /> 500-1000' — ` <br /> � Dace o Council Approval: — <br /> Hardcover Variance Reauire : Yes 1 p <br /> g uncil Approval Da[e: <br /> Grading: Staff Approval D e: y� - - <br /> Sepdc: Scaff Approval Date � By� <br /> Zoning File: � Reso aon: # <br /> � Reso tion Date: <br /> P�iY[ARKS (in house):' <br /> I <br /> F <br />