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STRUCTURE INFORMATION: � <br /> 1.Structure Dimenslons 1,3tructure�imensions(contlnued) 2.Type of ConstrucQon ' <br /> i <br /> 1 ; <br /> a.Lenglh(fl.)= �_ Number ot bedrooms=�1Cl�f� ood/Frame ? <br /> b.Widlh(ft.)= � Number ot garege stalls: ❑Masonry i <br /> Areas in sauare feet AUached= 3��S T C❑Metal <br /> � ❑Pole Bldg. ' <br /> c.Basement= /V� Detached= � ��' sT ��C� <br /> d.1�Story = f11'�'�' <br /> � ❑On-site Prefab <br /> e.2nd Story= <br /> N ❑Off-site Prefab <br /> f. '/:Story = � <br /> � ❑Olher(ptease speaty): <br /> g.7otai Area= <br /> i <br /> REQUIRED SUBMITTALS: � <br /> All of the information must be submttted in order for our a lication to be rocessed: � <br /> Not ' <br /> Enctoaed A Iicable � <br /> ❑ Permit ication <br /> jJ ❑ Pro osed Buildin Plans <br /> ❑ MN Slate Ener Code Calculations and Mechanical Code Re uirements Form i <br /> � ❑ Surve meetin all re uirements <br /> ❑ ,.S Stormwater PoHu6pn Preventbn Plan j <br /> .� ❑ Hardcover Calculatlon s � <br /> ❑ Se tic S stem S(te Evalualion R ort ' <br /> ❑ Access Permit � <br /> ❑ WeQand BuBer lm rovement Plan i <br /> ❑ fi.' En Inaered Plans/or Retainin Walis 4 feet or above ' � <br /> ❑ Minnehahe Creek Watershed DlstdG Pertnit s I � <br /> O f'lan Review Fee � ' <br /> ❑ ❑ Olher, t <br /> i <br /> � <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> • Agrees to provlde afl informallon requlred or requested by lhe Building Reparlment; <br /> • Agrees to pay lhe City of Orono for englnaering consultant review costs in excess of;500; <br /> i <br /> . Certifies that the Information supplied is irue and correct tA�e best of hislher knowledge. The appticant recognlzes that they � <br /> are solely responsible tor submitting a complele epplicailon being aware that upon fallure to do so,the staff has no altemative � <br /> but Io reject it untll(t Is complete; : ! <br /> • Acknowledges Ihe Escrow Agreement Is completed and sfgned; j <br /> • Understands some or all of lhe information Ihat you are asked to provlde on tlus appYcalion is classifled by State law as eflher � <br /> private or confldenlial. Private data(s IntormaUon which generatly cennot be given to lhe publfc bat cen be given to the subJect � <br /> of lhe data. Confidentiai dete is Iniormatfon which generaily cennot be given lo etlher the public or lhe subject oi the data. Our t <br /> purpose and intended use of this information is to annually npdate our records and records of olher govemmanlal agencies � <br /> required by law. If you retuse to supply the intocmatfon,the applicafion may not be issued. I <br /> � <br /> • Agrees thet in the event that weather or other condltions prevenl the completion of an as�ulk aurvey at the Hme the ' <br /> Certtficate of Occupency Is requested,a temporary Certfficute oi bccupancy may be leeued upon receipt of e 510,000 <br /> escrow to encura compietion af the as-buflt sunrey and a11 site Improvemante. <br /> �-- <br /> Applicant's Sfgnature: Y ^ 1 Date: �"���Z /� <br /> Owner s Signature: �� v • Date: _ O�8 (3 <br /> Packel Lasl Updated.• 04H9/2013 � <br /> ' <br /> Page 23 0(23 � <br /> F <br /> � <br /> I <br /> i <br /> i <br /> I <br /> I <br /> , <br /> �� <br /> i <br />