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11/��015 08 : 21 T0: 19522494616 FROM:6123544154 Page: 3 <br /> �. ,� <br /> STRt�CTURE INFORNiATl�N: <br /> 1.Structure Dimensions � 1.Structure Dimensions(continued� I 2.Type of Constructian � j <br /> i <br /> ' a� Length(ft.)- Number af bedrooms= � <br /> � ( ❑�Nood I Frame � <br /> � �I n.Width (ft.)= � Number of garage stalts: � ❑ Masonry ! <br /> � Are�s in square feet � Attached= ❑ Metal <br /> ❑ Pole Bldg. ' <br /> c. Basement= ; Detached= � ��F <br /> ci. 1"Story = � <br /> ! ❑ On-site Prefab ' <br /> , e. 2��Story= ( <br /> ❑ Off-site Prefab <br /> f. 'i7 Story = <br /> � � i ❑ Other{pleas�specify}: �� <br /> ', g Tot�l ar�a= ( t __ <br /> i <br /> '�------______---�________ I <br /> REG�IliRED SUBMITTAL�: <br /> All of the information rnust be submitted in order for yaur application to be processed: <br /> , _. r __ ---- - — --- --- -- - — <br /> --- �_ _ <br /> � Not � �__.._. __�_ ._ --- --� <br /> Enclased �Applicabie <br /> �� ,_�.__ 0� ❑ �'� Permit Ap�ficatiort <br /> � - ---.` _._..___ _ ----- ,� <br /> � � � __. ' Proposed Building P(�ns - _ � <br /> ;_ � � � MN State Enerc,�Cade Calculations and Mechanical Code Requirements Form <br /> L7 '� C) Survey(meetinq all requi��ements) <br /> � d ��i �1 � Stormwater polEution Prevention Pl�n �� <br /> --- _ _ _ —__ � � <br /> � � � �� �, i-fardcover Calculatian�s) <br /> � __ __.._._—�,�.... __ ____ -- ---_ _. _ - —__. . _-- —.._._.__ — ---- -- --......... <br /> � C1 ' S�tic System Site Evaivatian Report _ , <br /> ------- _ .. � -- _ , <br /> �� Cl ; C1 Access Permit ; <br /> � �__ � _ � ❑ i Wefland�uffer imprc�ver��ent Plan �� � �� � <br /> --- --- _ <br /> � � ��--- ❑ �fi Enqineered Plans tor R�taiiiinc�Walis 4 feet or above � <br /> n <br /> _�. _— --- ----� <br /> � i ❑ �Min�ehaha Creek Watershed Oistrict Penr�it s <br /> _� _� ._....___ ❑ <br /> ___�.__ _ _. _.___ �_._ --- .____ _)__�.__�___. ....�.----.___�___�._.__� <br /> _,_.. � � Plan Review Fee <br /> � ! ❑ � Applicatian Escrow&Agreement Y � ' <br /> � -�- � _�__.. ---- - <br /> � � Other. <br /> � _ , <br /> APPLICA�6TICJWNEI4 AC6{t���lLEb���t1ENT: <br /> —_____ �__._ ----^_.__ �__..._—_________ _____. <br /> ' • l�grees ta provide alI infiormation required oi�requestetl by the Buildiny Department; I <br /> + Agrees to pay the City of Qrono for engineering con5ultant review costs in excess of$50�; <br /> i Certities that the ii�formation si�pplied is true �nd carr2ct to ihe best of his/her knowledge. The applicant recognizes that the;� � <br /> are solely responsibie for subinitting a coi��plete application being aware that u�on failure to do so, the staff has na aiternatis�e <br /> � l3ut to r�ject it unti(it is complete; <br /> o Acknowiedges the Es�row Agreement is com�letetJ and signed; II <br /> � Uncierstands some or ail of tf�e information thai ynu are asked to �rovicf� un this application is classified by 5tate law as either I <br /> �rivate or confiden[ial. Private data is information which generally cannnt be given to fhe public but can be given to the subject <br /> of the data. Conndential data is information which generaliy cannc�i be given to either tf7e public or the subject of the ciata. Oiu <br /> purpose and intended use of this information is io annually upciatz our records and records of other governmental agencies I <br /> re�uir�d by law. If you refuse to supply the iniormation, the applicatibn m�y nat be issued. � <br /> � <br /> • Agrees that in the�vent�hat weather�r other conditians prevent the completior� af an as-t�uilt survey at the time the ! <br /> Certi�cate of CJccupancy is reque$ted, a temporary��r�ificate of Occupancy may be issued upon re�eipt t�f� �1�1,OpQ � <br /> �� escrow to ensure�ompfetian of the as-bailt survey and aIl site improvem�nfs. <br /> i <br /> ___ __.._.. --__—_.__ _____--_ ___ .. __ _-----..--_ --- <br /> __ —_____ __ ____T__-----) <br /> �pp(ic�nt's Signature: Date: � _ <br /> C7wner's Signature: _ _.__�_�_ _._ Date: <br />