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CHECB OFF LIST FOR ISSUANCE OF PERMITS <br /> ` FOR OFFICE USE ONLY <br /> ' ADDRESS OR LEGAL: �(3(�� /UORT1y SHo2�'� Di2� V C,; . <br /> PID: <br /> DESCRIPTION OF WORK: ��Lk <br /> ZO�TING REVIEW BY: � DATE APPROVED: �-?�-0 2 <br /> BUII..DING REY�W BY: DATE APPROVID: S-z�-02 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes .� No <br /> PLAN REVIEW Yes r/ No SEVVER CONNECTTON <br /> STATE SURCHARGE Yes—� No WATER CONNECTION <br /> IIWESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SFTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CB LIST Zoning District: <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq�.ft. �/N�H�v Acres �.o r � Width lt3 Depth 38$�Vl' <br /> Survey Submitted: Yes oc No Date of Survey: . o� ti�c•� <br /> Progosed Setbacks: � <br /> Front(I.ake): Right Side: <br /> Reaz(Sueet): Left Side: <br /> Adjacent Structures: __�,�-+auf P� Wedand: OJ l� <br /> Building Height: Def. Hgt. _ itI/,�+ Peak Hgt. �//A <br /> L.ot Coverage: V�1� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resoludon: # Resolution Date: <br /> Shoreland District: ��?5 <br /> Avg. Setback: N//i Bluff Setback: i✓!/� LotCoverage: a•�� <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' 23.00 <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />