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Date `�� <br /> PLAt:N2NG DEPARTN�EWT TtLVILW <br /> Plan Check tJo. • ��� /�;'-:�7`j� . <br /> i <br /> SEPA No. • <br /> �,er:��t'p��) ��_ — <br /> Address (if Y,nown) :�,� � <br /> Zoning• <br /> ___�_-_---------------— <br /> Lot Area• <br /> ------------------ -------- <br /> 13eight Limitation: <br /> Use of Building�^ �'� � <br /> �.jCC��- --�_ ' <br /> Special Considerations;. <br /> CON�:SNTS: <br /> Ditn of. c�nunnnt <br /> . nPPROVED: <br /> �� � '�� �1t�� ��I o � <br /> Signa�eure Date <br />