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CiiEC�K OFF i�IST FOR ISSUANCE O�' �ERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: �..S�c; Nuazrt-� �+�-��- 'Q2� <br /> PID: <br /> DESCRIPTIO�i OF WORK: Zr��i �--��2 (��_���✓� �-_ <br /> ZO.VI�Ii G REVIEtiV BY: DATE APPROVED: v- �� �s <br /> BUILDING REYII���V BY: r DATE APPROVED: y - � -� s <br /> FEES TO BE CHARGED: Misc, Fees Caiculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIE`� � Yes —� No SEtiVE.R CONNECTTON <br /> STATE SURCHARGE Yes —� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ./� PARK FEE <br /> SAC Yes No � STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ------------------------------------------------------------------------------------ <br /> ZO�II�IG CH�CK LIST Zoning Discrict: V� v ���C <br /> Fire Department: Post O�ce: School District: <br /> Loc Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No \��,� Date of Survey: <br /> \ <br /> Proposed Setbacks: <br /> Froa[ (Lake): Right Side: <br /> ; <br /> Rear (Street): Left Side: � <br /> Adjacent S[ructures: Wefland: <br /> Building Hei�t: Def. Hgt. Peak Hgt. <br /> Lot Coveraje: <br /> Grading: Staff Approval Date: ` By: Council Approval Date: � <br /> Sepcic: Scaff Approval Date: <br /> \ <br /> Zoain; File: # Resolution: #_� Resolution Date: <br /> Shoreland District: <br /> Av�. 5etback: Bluff Setback: L,ot Coverage: <br /> Ex.isti.nQ Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-SQO' <br /> 504-1000' <br /> Hardcover Variance Required: Yes No Date oE Council Approva?: <br /> RE`�L4RKS (in house): <br /> -, <br />