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CHECK OFF LIST FOR ISSUA2r'CE OF PERI�IITS <br /> FOR OFFICE USE ONI.Y • <br /> ADDRFSS OR LEGAL: 31! !..t v�N�ST o t•l _, - � � . <br /> PID: <br /> DESCRIPTION OF WORB: �,c w rt.�.5 <br /> ZO�"G REVIEtii�BY: DATE APPROV�D: 3.�5 •oo <br /> . �. BL�DL�tG REY��Y BY: � � ' DATE APPROYF�; 3-24-O° ' <br /> FEES TO BE CHARGED: � Misc. Fees Calculated By: <br /> pER�1�IIT Yes ✓ No � <br /> pLAI�I REV�W � Yes ✓ No SEWER COY!`'FCTZON <br /> STATE SURCHARGE Yes ,/ No � �VATERCOIV�v'ECTION -�3.So•v� <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes � No � � SITEI�i TSPECTTON <br /> Number of SAC•Units � OTHER(specify) <br /> ZO`Zti G CH�Cg LIST 2oaino Districr. �R -�c - ! _ <br /> Fire Department: rvw u�•n� Post Office: wq r—c,4� School D?sLLicr. t�Ps _ <br /> Lot Area: Sq.fc. I��t b5.�2 Acres , O'-i 5' Width 3V.`1 Depth (0`�.03 <br /> Survey Submitted: Yes X No Date of Survey: 2 'Z �g-aa <br /> Proposed Setbacks: � � <br /> Ftoat(I.a..�ce): 22 � Ri�h:t Side: ' (� - � . <br /> . � � <br /> Reaz(Screet): G L,eft Side: <br /> Adjacent Structures: �.T�-,e�c.�tc3�D d� �Vedaad: /+�l r4 <br /> Buildiag Hei�h[: Def. Hgt. C�•l�- Pea.l Hgi. <br /> Lot Covera�e: N��' • <br /> Gradin�: Staff Approval Date: a.K By: .��- Couacil?,ppro�-al Date: <br /> Sepdc: Staff Agproval Date: /U /�' By: <br /> Zoain�File: � � Resolution: � R:soludoa Date: '. <br /> Shoreland District: � <br /> Av�. Setback: Btuff Setback: LatCo�zr�e: <br /> • Ezistma Progos�d � <br /> ^J� Hardcovcr: 0-?5' __ . <br /> 75-?50' <br /> z�asao� _____ <br /> SQO-1000' <br /> Hardcover Variaace Required: Yes No Date o`Cou�ci? Approval: _ <br /> RE1��LARhS('in house): � S 1 r� . Q �••�r� u`*�� '1� <br /> f 2.� �(�2 'T'Z.� 3"7 c�"7 C.l�/►nrG 5�� `I}r� <br /> 7 <br />