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"STRUCTVy�.:: ::_._:::_< :_�=.:";�:�: <br /> � 1.StructurE� :.:Wrs;J:.� 1.Structure Dimensions(continued) 2.Type of Construction .�/�- � <br /> �1�- <br /> a. Length(ft.;= _���"_ ' Number oT bedrooms= 1"� �C�`���{��y ��L` i <br /> ood/ rame� <br /> b. Width (ft.)= _ `7�v '; Number of garage stalls: 3 ❑ asonty <br /> 3 - �� d� �c����%� � . <br /> Areas in so�.:�.: - Ait��nee = ❑ etal' � <br /> -- _ _ - ❑ P �Bldg. �.-��-��/(-� / <br /> c. Basemert= 1"�y� '�etached =_ G � ��� C�(�! % � /��j �l� <br /> d. 1St Story = Z.243__ '' '. <br /> ❑On�si Prefab <br /> e. 2�d Story - ��.�Y°a Off-�ite refab <br /> f. '/2 Story �_ __ Other�(gl ase specify): <br /> g. Total Are�- 4�z 3$_ <br /> REQUIR� ���' -_,W°�.�_�; <br /> All of the :� -, =t��� must be subrr;;tte� in order for your application to be processed: <br /> � Not <br /> Enclosea � ".;��:licabie <br /> ❑ f, Buildi.no Permit Escrow A reement and Fees <br /> p ❑ ' Plan ;�eview Fee <br /> ❑ - ; Com leted A lication Form <br /> ❑ � �rc�c::ec: 3ui!d n Plans-2 full size sets,to scale and 1 reduced 11 x 17 or 8'/2 x 11 set <br /> ❑ r� Minnesota State Ener Code Calculations and Mechanical Code Re uirements <br /> ❑ �^ Survev-2 fu!I size, to scale meetin ALL surve re uirements <br /> ❑ ' -lardccve;Calculations <br /> ❑ �e�tic S ster:� Certification <br /> ❑ lllirn2h:a`?a �reek Watershed District(MCWD) Permit or <br /> �cc::�^��'atic^ 'rom MCWD statin no ermit is re uired <br /> ❑ _ands�a�2'��,'a!Is and/or Retainin Wall Plans <br /> ❑ S!cr^-.�Nater Po!lution Prevention Plan SWPPP <br /> � ---- -=— ^-.ccess Pe•�.�t <br /> ----=- " <br /> ❑ � �ata �'�n���r���Advisc Form / <br /> APPLIC�_;� � � r� �� Y,rKn�����,:��� ,�.;_�!T: <br /> • q5re��*^ ;-^: : = �: ;�:a�^^ati^r;req:�ired cr requested by the Building Department; <br /> • AgreE�xt o�y ,r:��.ity ofi Or�x�a f�r er,�i�eerir�g co�sultant review costs in excess of$500; <br /> • Cert' -a _ �a: �r�e inr.;:ma�lon s,,eoiie� �s�rue and correct to the best of his/her knowledge. The applicant recognizes that they are <br /> sc'E: - � T � �. _ _ _ _�r!ication being aware that upon failure to do so, the staff has no alternative but to <br /> re;e�- ' ,;,r�� �i,�c�-�nle+= <br /> • AcKr,;�,^�,�ues t�-�e �:=�cro�.�: .�� ��r�e� _ _. ,c�pletea ana signed; <br /> • Urde;s_:r:s :c�= ;�al! of;ha infcrmaUon tnat you are asKed to provide on this application is classified by State law as either <br /> pr:��.:: -;� , , c�i.,:';. '�rivate data :s information which generally cannot be given to the public but can be given to the subject of <br /> th_- >! ;:a � ,�far-� ':� � .,' i,:h generally cannot be given to either the public or the subject of the data. Our <br /> p��~�,::��,_ � -w ,`�-,:::� _��,e of this inrcrmation is to annually update our records and records of other governmental agencies <br /> rea.'r�� �, ��;�;. �t .,.��� ��fuse to supnly t'�e ir.formation, the application may not be issued. <br /> • Ac.� :E��t� i�� t!�e �=vc�i�t. zha4�n�eatheF�or Qtiher conditions prevent the completion of an as-built survey at the time the <br /> C^�^'- ��.te c�+ C'cc�.r�r�i�c1+ �� req��estecl, a .*er.rporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> es�- cr:;*�.��•��-^i����'�*G�^iz of t�e �s�t�«�It sun�ey and all site improvements. <br /> -�-�- c.��S�,�..4-.r. • <br /> ApplicanYs �I ��� Date: ��-Z�- (7 <br /> �S <br /> Owner's Siy_� ____��_�� �ate: <br /> Packet Last ur,<:-. <br /> Page 22 <br />