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�CHECJK OFF �,IST FOR ISSUANCE OF PERi'VIITS <br /> " FOR OFFICE USE ONLY <br /> ADDRESS OR LEirAL: 3 b0 LQ.a� .Sh�a��`" <br /> PID: �Y /a.m..c��� <br /> DESCR�i.'ION OF WORK: r a.�e._. 2. -�- <br /> ---------------------------=------------------ <br /> ZOY.�i tG REVIE`�V BY: --------____� DAT'E APPROVED: <br /> �UIZDING R.EYIE`V BY: DATE APPROVED; �-zr-o c, <br /> FEES TO BE C�-TA,RGED: Misc. Fees Calculated By: <br /> pE��T Yes ,/� No <br /> PLAN REVIEti�V � Yes f No SE��R CO�TNEC'ITON <br /> STATE SURCHARGE Yes —� No tiVATE.RCONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes N.a� STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ----------------------------- <br /> ----------------------------------------- <br /> ZO�� C�CK LIST Zoaing Distric�: � - � �_, <br /> Fire Departmen[: Post Office: School District: � <br /> Lo� Area; Sq.ft. Acres Widch Dep�h <br /> Survey Submitted: Yes � IVo Date of Survey: �J ��P Q <br /> Proposed Setbacks: 1�,r�'1 �� � <br /> Froat�: 1 �' A�t Side: <br /> �v►a. o gc. <br /> Rear(�: !�` �e€tCSide: J�' �. 3 <br /> � O i <br /> �.i�3�P�t .CrrLtC�1LZ5; _ (V WPC�?.rSC�: <br /> -' /3' <br /> Builclin� Hei�[: Def. Hgt, 10,� Peal:Hgt. <br /> Lot Covera�e: ��- <br /> Grading: Staff Approval Date: N//-� By: Council Approval Date: ' <br /> Szptic: Scaff Approval Dace: N /c/� ,��...�<n BY� <br /> Zonin� File: � '� Resolution: n — Resolutioa Date: <br /> Shoreland Dis[rict: A(f� <br /> Avg. Setback: B!uff Setback: Loc Coverage: <br /> Ecistina Proposed <br /> Hardcover: G-7�' <br /> 7�-250' <br /> 2�0-500' <br /> 500-10C�' <br /> �� �i0 D3C� Oi COILC:i :�pYID`.'�: <br /> H��eco��er Vas':2nce Req�.red: Yes <br /> RE�L4RI�S (inhouse): 1/�IZ�-�2v�e� tS � �'^�¢� 3 ^ ����Z b`�� <br /> ��¢dr eSs�e.s na�-hnc.a�!�'P��� k- -k' �v"�-�_ '' <br />