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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> - FOR OFFICE USE ONLY <br /> ` A.DDRESS O LEGAL: k�EN�: �4�& <br /> PID: <br /> DESCRIPTIO OF WORK: �uc. 3 sc�so•�t "o2UJ, <br /> ZO�Tl�Ii G RE W BY: DATE APPROVED: -�" —"�/ <br /> BUII�DING VIEW BY• DATE APPROVED; s- —o <br /> FEES TO BE HARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes v No <br /> PLAl�T REVIE Yes �' No SEWER CONNEG"ITON <br /> STATE SURC ARGE Yes � No WATER CONNECTION <br /> INVESTIGAT ON FEE � Yes No PARK FEE � <br /> SAC Yes No STTEINSPECTION <br /> Number of AC�Units OTHER (specify) <br /> ZONING C CK LIST Zoning District: <br /> Fire Department: Post OfFice: School District: • <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted Yes �� No Date of Survey: o�r ��� <br /> Proposed Setbac : � <br /> , <br /> Front( e): � � Right Side: 72 � <br /> Rear(Str et): /o�` � Left Side: �30' + <br /> Adjacent Structures: ,4-rr�� �Vetland: N/r� <br /> Building Height: ef. Hgt. n-!Z Peak Hgt. <br /> Lot Coverage: �� <br /> Grading: Staff A proval Date: — By: Council Approval Date: <br /> Septic: Staff App oval Date: — By: <br /> Zoning File: #� Resolution: # Resolution Date: <br /> Shoreland District J�� <br /> Avg. Set ack: Bluff Setback: L.flt Coverage: <br /> Eusting Proposed <br /> Hardcov r: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcov r Variance Required: Yes No Date of Council Approval: <br /> REMARKS (' house): <br /> 7 <br />