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STRUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= �_ Number aF bedrooms= �Wood/Frarr�e <br /> _�; Masonry <br /> b.Width(R.} �� Number of garage stalls: ❑Metal <br /> ' Attached= ❑Pole Bldg. <br /> Areas in sauare feet Detached= ❑ ICF <br /> ❑On-site Prefab <br /> c.Basemerrt= ❑OfF site Prefab <br /> d. 1'`Story = ❑Other(please spec�fy): <br /> e.2nd Story= <br /> f. %z Story = <br /> g.Total Area= ,�G� - <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your ap lication to be rocessed: <br /> Not <br /> Enclosed icaWe <br /> 0 0 Permit lication <br /> 0 ❑ Pro Buildin Plans <br /> ❑ ❑ MN State Ener Code Calculations and Mechanical Code R uirements Form <br /> 1� ❑ Surve meetin all r uirements <br /> ❑ 0 Stamwater Pollution Preverrtion Plan <br /> O � Hardcover Calculation s <br /> ❑ 0 Se 'c S stem Site Evaluation R rt <br /> 0 ❑ Access Permit <br /> O ❑ Wetland Buffer Im rovement Plan <br /> � ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> 0 ❑ Plan Review Fee <br /> ❑ ❑ Other <br /> APPLICANT ACKNOWLEDGEMENT: <br /> . Agrees to provide all information required or requested by the Building Departmerrt; <br /> • Agrees to pay the City of Orono for engineering cor�ultaM review cos�s in exc�ss of�500; <br /> • Certfies that the information supplied is true and oorred to the best of his/her knowledge. The applicarrt recognizes that they <br /> are solely responsible for submitting a complete applic�tion being aware�at upon failure to do so, the staff has no aftemative <br /> but to rejed it urttil it�aomplete; <br /> . Adcnowledges the Escrow Agreemerrt is completed and signed; <br /> • Some or all of the informatia� that you are asked to provide on this applic�tion is dassified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subjed of the data. <br /> Conf"idential data is iMormation which generally cannot be given to eRher the public or the subjed of the data. Our purpose and <br /> i�ended use of this information is to annually update our reco�ds and�ecords of other govemmental agencies required by law. <br /> If yoou refuse to supply the infom►ation,the application may not be issued. <br /> ApplicanYs Signature: Date: C� <br /> Last Updated: 5/21/2009 <br /> -21 - <br />