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. � <br /> CHECK OFF LIST FOR XSSUAIVCE OF PERcti,fITS <br /> FOR OFFICE USE ONL Y <br /> ADDItESS OR LEGAL: 40c'� C_�AF 5T <br /> , <br /> PID: <br /> DESCRIPTION OF yVORK: /V Cw 2C5 <br /> ----------------------------------------------------------------------------------- <br /> ZO�YItYGREVIE6VBY: e DATEAPPROVED: f.,�-os" � <br /> BUILDI[YG REVIEW BY: :DATEAPPR06'ED: 2-3 -o� <br /> ------------------------------------- <br /> FEES TO BE CHARGED: hlisc. Fees Calctctated By�: <br /> PER1l�tIT Yes ✓ No <br /> PLANREVIE6V Yes ,/ �vo SEYYERGONtVECTION <br /> STf1TE SURCHARGE Yes_ r�� tVo YVATER CONtVECTIOtV <br /> I�VVESTIG,�iTIO�V FEE Yes tVo �/ PARK FEE <br /> Stl C .Yes 1Vo x SITE NSPECTIO��( <br /> Nctmber of SAC U�tits �� �� OT'HER (specify) " <br /> ----------------------------- <br /> _ a�_�_z�_-3----'-�r`----------------------------------------------------------- <br /> 2'O�VIIYG CHECh'LIST Zor�i�:;Dtsa•tcc: fLR- +l3 <br /> Fire Depnrtrnerrt: Post Office: School District: _.. <br /> � <br /> Lot.�lrea: 5q.ft. . �����tc�•es 3�.313 YVicfth 211.� Depth <br /> Sui-vey Su6rnitted: Yes� No Dc�te of Su�vey: oGT �S 200� <br /> Proposed Set6acks: , <br /> F�we�x�t(Lalce): .�1 Rig/it Side: 5V•S" <br /> i <br /> R�r(Sh•eet): �7 Left Side: � <br /> Adjacent Sh•uctui•es: N/l� ��etlRnd: Ib��{ <br /> Buildirig Height: Def. Hgt. �) Peak Kgt. 36 <br /> Lot Coverage: �`1•M�a <br /> �•v' — <br /> Grading: StRff.4pproval Date: Z.•3•oS .�„�_ By: �� Cot�nci!Approval Date: <br /> Septic: StnffApproval Dccte: /���} BY� <br /> Zonir:g File: # oS�3D7i Resolution: # Resoli�tion Dnte: l •Z`/� °S <br /> Shoreland Dish•ict: /If D <br /> ,4vg. Setback: Blufj`'Setback: Lot Coverage: ci•'��a <br /> Existing Proposed <br /> Hardcove�•: 0-7�' <br /> 75-250' <br /> 250-500' �— <br /> 500-1000' <br /> Harcicover Variance Rec�uirec�: Yes No Dafe of Coiutcil Approval: <br /> .REMARKS(irc ltottse): <br /> 31 <br /> f i, i1'� 1, (ii 'SI9 �i ��� liii � i a�. i�l �i2i (�f : �� ��� ,r; ,� j i ,i��,( � �( �p�� ����� ��Y}��� ",��,1 <br /> ��p <br />