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, ' <br /> � CHEC�i OFF LIST FOR ISSU��TCE OF PERiI�IXTS � <br /> _ FOR OFFICE USE ONL,Y . , ' . ' . <br /> p,�DgESS ORLEGAL: 311�1 L � VING STt�� <br /> PID: <br /> DESCRIP'IZ4N OF S'VORK: /� `. c�s i2.�S _ <br /> , <br /> ZOr�G REVIE�'V BY: D�TE APPROV�D: S- '► - �1 � <br /> BUIZD .T�i'G REYIE�BY: n,,;,,�.— . D�.TE APPROY�D: S-g -�t . <br /> FEES TO BE CH.4RGED: i�iisc. Fees Calculated By: � <br /> PERMI"T Yes �/' No � . ° :, <br /> PLAN REVIEW Yes � No SESiTER CONNECTION <br /> STATE SURC�IARGE Yes �/ No �ATERCONNEC'ITON <br /> I�,TVESTIGATION FEE Yes I�o PARK�EE <br /> SAC ' Yes v� No SITEINSPECTION <br /> Number of SAC•Unics 1 OTHER (specify) <br /> ZOtiZ:�TG CH�CB LIST Zoning Disnricc: L2 -1 G- I <br /> Fire Department: �1M»rr� Post Ofuce: W Ay7�t-� School Dis�ict: c�-=�E S�–o N�- • <br /> I.vt Area: Sq.ft. ,D Z a � 1 Z$ c� ��"idch Z o Depth (o`-� � <br /> Surve;Sub�itted: Yes oC. No Date of Survey: Y'�" d � <br /> Proposed Setbacks: � � <br /> Front(La.�Ce): /S Ri�ht Side: " o � . . <br /> Rear (Screet): / S Lefr Side: O <br /> Adjaceat Structures: �¢�c.�� tiVetla::c: /V /1� • <br /> Buildin�Hei�ht: DeE. H�t. Q. ��. Pea.k H;t. C� .l� <br /> Lot Covera�e: N�� � <br /> Grading: Scafi Approval Date: _ D� (.L gy: /"-"• Council Approval Date: �"' <br /> Septic: Staff Approval Date: /✓ //� By: <br /> Zoaiag File: � — Resolution: � Resolution Date: . . <br /> Shoreland District: — � <br /> Av�. Setback: Btufi Setback: LotCo�•era�e• <br /> E���o Proposed <br /> � <br /> Hazdcover: 0-75' . <br /> 75-250' <br /> ti0-SQO' . <br /> 500-1000' <br /> Hardcover Varia.nce Reqaired: Yes No Date of Council Aoproval: <br /> REI�IARb,S (in house}: <br /> 7 <br />