2017-00331/00332-VOIDED PERMITS - Laserfiche WebLink

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STRUCTURE INFORMATION: ' 1.Structure Dimensions 1.Structure dimensiot�s(contirwed) 2.lype of Construction ' a.Length(ft.)= � I Number of bedrooms= � �W��prame b.Wdth(ft.}= �� i Number of gerage stalis: ❑Masonry � Areas in square feet Attached= �- ❑�etel ❑Pole Sldg. c.8asement= /C,TS$ i Detached= Q ICF d.1g Story = �_ � ❑On-site Prefab e.2r°Story= ❑Off-site Prefab f. %z Story = �Y� � � ❑Other(please specify}: ; g.Totai Area= I REQUIRED SUBMITTALS: All of the informai�on must be submitted in order for our a licatfon to be rooessed: Not '._._.... EnGa 3 Ap�licable Y ❑ Buildin Permit Escrow reement and Fess ❑ Plan Review�ee ❑ Com leted ication Form ____ ❑ Pro�osed Building Plans—2 full size sets to scale and 1 reduced 11 x 17 or 8%z x 11 set :............................... ........_........ �.....�_...�_____ � Minnesota State Ener Code Calculations and Mechaniql Code R uirements ❑ Surve —21u11 size,to scale me�in ALLsurve r uirements ❑ Hardcover Calculations i........................... .__........__....... ........,,,............___.... ._....._ ................._..................__....__......—._�__..._._ _ ___..........._.........__.........._...______ � Se ic S stem Certification L] Minnehaha Creek Watershed Distrid(MCWD)Permit a Documentation from MCWD stetin no ermit is re uired a }________,__ i ❑ �S. _: Landsca�e Walis and�or Retaining Vdall Plans ;.........._.......___—._—_ ; ❑ y1 �Stormw�ater Pollution Prevention Plan SWPPP ,__ ��_,.,,_...,_..._......_.—_ ; ❑ Access Permit ; _._.. —_.._ i........................_�....__.. _—.....� t...Data Privac�Advisory Form APPLICANTIOWNER ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the 8uilding Department; • A�ees to pay the City of Orono for engineering consulWrrt review costs in excess of$500; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a corr�lete application being aware that upon failure to do so,the stafi has no alternative but to rejed it until it is complete: • Acknowledges the Escrow Agreement is completed and signed; • Understands some a all of the information that you are asked to provide on this application is classified by State law as either private w confidential. Private data is information which generally pnnot be given to the public but can be given to the subjed of the data. Confidential data is information which generally cannot be given to either the public or the subjed of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agendes required by law. Ifyou refuse to supply the information,the application may not be fssued. • A�ees that in the event that weather or other con�tions prevent the completion of en as-built survey at the time the Certificate of Occupa�cy is requested,a rerrporary Certiflc�e of Occupancy mey be issued upon receipt of a S10,000 escrow to ensure completion of the as-built survey and all site improvemerrts. '— =r^----- . _ -- / ,�� Applican#'s Signati�e/�/" ,,�_.,.,._/L�� Date: � — 3l� � 7 t. Owner's Signature: Date: Packet Last Updated August 20?5 Page 22