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, . <br /> STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimens ns(continued� 2.Type of Construction <br /> a.Length(ft.)= Number of bedrooms c ❑Wood/Frame <br /> �Masonry <br /> b.WIdtF►(ft.)= Numberofgarage staNls: ❑Metal <br /> Attached� ❑Po�Bldg. <br /> Areas in sa�ara� Detached= ❑ ICF <br /> ❑On-site Prefab <br /> c.Basemen� , ❑Of�aite Profab <br /> d. 1 s�Story = ❑Other(p�ease specity): <br /> e.2nd Story= <br /> f. 'r4 Story = " <br /> g.Total Area= � <br /> RE�UIRED SUBMITTALS: <br /> All of the information must be submitted in order fqr ur a lication to be processed: <br /> Not <br /> Endosed A licable <br /> � O Permd lication <br /> Q O Pro d Buildin PI ns <br /> 0 MN State Ene Co Ca�ulatfons and Mechar�cat Code utrements Form <br /> � Su meed all ulrements <br /> � Stormwater Pollution PreveMion Plan <br /> O HaMcover Ca�ulati s <br /> 0 Se tic S stfm 3lte luatlon RQ rt <br /> 0 Access Permit <br /> O Wetland Buffer Im ement Plan <br /> L7 En ines►ed Plens fo Retaini Walls 4 feei or above <br /> ❑ O Plan Review Fee <br /> ❑ O Othar <br /> APPLICANT ACKNOWLEDGEMENT: <br /> . Agrees to provide all informaUon required or request by the Building Department; <br /> • Agrees W psy the City of Orono for enginesring onsultant roview costs in excess of;500; <br /> • Certifies that the ir�fortnatiMal suppiied is Uue and c Irrect to the besi of hislher knowledge. The applicant recognizes lhat lhey <br /> are�olely responsible for submitdng a complete ep�licatbn befng aware that�on failure to do so,the staff has no alGemative <br /> but to reject it untll it is complete; <br /> • Ackr�owledges the Escrow Agreement Is oompleted nd signed; <br /> • Some or ap of the inFortnatlon that you are asked provide on this application Is dassified by State law as either privete or <br /> confldendal. Private data fs InformeUon wNch 9ene {ly cannot be given to 1he public but can be gfve�to the subJect of the data. <br /> Confldential data is fnformation which genarally can ot be gtven to si�he�the pubtic or the subject of the c�ta. Our purpose and <br /> intended uae of this tnformetlon is to an�wally upda our records and records of ather povemmental agendes required by law. <br /> If you refuse to aupply the informetion,the appikatlo may not be issued. <br /> Applicant's Signature; _ Date: ���'�� <br /> Losl Updated: 9l29/2009 <br /> -18- <br /> i <br />