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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY 4410ADDRESS OR LEGAL: 4-/O /,S So 1i-t O4_O C/1 - 6,4-ti <br /> PID: <br /> DESCRIPTION OF WORK: RADcor l? A 2 <br /> ZONING REVIEW BY: /U (A DATE APPROVED: <br /> BUILDING REVIEW BY: e DATE APPROVED: 2- z-q‘. <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes // No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ,---- PARK IEb <br /> SAC Yes No J SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST zoning District: Shoreland District: <br /> Fire Department: h Post Office: School Distri : <br /> Lot Area: Sq.ft. Acres W dth 'epth <br /> Survey Submitted: Yes N a Date of Survey: <br /> Proposed Setbacks <br /> Front e): �--- ''ght Side: <br /> Rear (S' - t): Left Side: <br /> Adj• ,it Struc es: etland: <br /> Building Hei l-A t: Def. t. 'eak Hgt. <br /> Avg. Setbac.: : uff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcove : 0-75' <br /> 75-250 <br /> 250-500' <br /> 500-1000' <br /> Hard••ver Variance Require: Yes No Date of Council Approv. : <br /> Gra ing: Staff Approval D:te: By: Council Approv• Date: <br /> Sea tic: Staff Approval D• e: By: <br /> coning File: # Resol tion: # Resolution Date: <br /> ' • ' (in hi •): <br /> 26 <br />