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' � CHECK OFF LIST FOR ISSUA2�'CE OF PERitiIITS <br /> _ FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: 31y � l—�\f�1'V C�S'T� t`I C' n�2'� . <br /> PID: <br /> DESCRIPTION OF WORK: C l2E S <br /> . - <br /> ZO�'G REVIEti�BY: DATE APPROYED: _�c�•3�C�o <br /> BUILD�iG REYIEtiV BY: DATE APPROYED; � o �3=�a <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes �/' No :. <br /> pLAN REVIEW Yes �/ No SEWER C0�INECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECITON �S-�`�` <br /> INVESTIGATION FEE Yes No �_ pARK FEE <br /> SAC Yes ✓ No SITEINSPECTION <br /> Number of SAC�Units �... OTHER (specify) <br /> ZONL�tG CHE.CB LIST Zoning Districc: _�/L- /G- � <br /> Fire Department:�/lN��! (� Post Office: W A� School District: W CS 7"U N�-� <br /> Lot Area: Sq.ft. ��i� Acres .(�`�( Width '3 U Depth (��( <br /> Survey Submitted: Yes_� No Date of Survey: 9' 1 y'�� <br /> Proposed Setbacks: � <br /> Front(La.ke): 2 Z.. Right Side: � ! � _ <br /> Rear(Screet): (fl Left Side: � <br /> Adjacent Structures: 14�Cl-t c=� Wetland: �'�' . � <br /> Buildin� Heiaht: Def. H;t. � ,�� Peal:Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Dace: By: <br /> Zoning File: # Resolution: � Resotution Date: . <br /> � " Shoreland District: <br /> �� Ava. Setback: Blufi Setback: Lot Covenge: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Couacil Approval: _ <br /> REI�LA.RKS(in house). <br /> 7 <br />