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Jun 22 12 07:36a Dale Crawford 9522490603 p.2 <br /> STRUCTURE lNFORMAT14Ai: <br /> i.Svucture Dimensions 1.Structure Oirnensions(condnued) Z.Type oi Constnicdon <br /> � a.Length(ft.� ��� Number of bedroarns= �jNp��Frame <br /> � r_..� <br /> b.Width (ft.f= �,� Numbe�of garage slalls: ❑Mascnry <br /> Ateas in sa�are Feet q��y�= ❑ Metal <br /> ❑Pole Bldg. <br /> c.Basemerrt= ��e�_ ❑ICF <br /> d. 1"Slory = <br /> D o�-�e p�ab <br /> e.��s��,,= � � � <br /> ❑o�S�te�era� <br /> f. '/,Stnry = her lease s <br /> (A P��Y)� <br /> g.Total Araa= <br /> REQIiIRED SUBMITTALS: �"���D <br /> Alt ot the infarmadon must be submitted in order€or our a lication to be rocessed: <br /> kot <br /> ' En sed A li le <br /> Permit A ication <br /> ❑ Pro osed Buidin Pfans <br /> � MN State Ener Code Calculalions and Mechanic�Code R urBments Forrn <br /> O Surve mee6n all re uirements <br /> � Storrnuvater PqMution Prevention Plan <br /> O Hardcover Caiculatian s <br /> 0 Se tic S Site Evaluation Re <br /> O Access Permit <br /> 0 Weqand Buffer Im rovemeM Plan <br /> O En ineered Plans for Retainin WaJls 4 feEt or above <br /> O ❑ Plan Review Fee <br /> � 0 Other. <br /> APPLICANT/OWNER ACKNOWLEDGEMEfVT: <br /> • Agrees to provide all informatbrt requirad a requested by the B�eldrng Departrnent; <br /> • Agrees to pay the City of Orono for engineering consultant review costs:n excess of i500; <br /> • Certifies that the informatian supplied is We and carect to tlie best of hislher knowledge. The applicaM recognizes that Uiey <br /> are solely responsible far submitting a complete application being aware that upon fa�ure to do so,U�e staf�has na a#�mative <br /> but to reject it unW it is oomplete; <br /> • Acknowledges the Escrow Agreement is completed and signed; <br /> • Understands some or all of the irrfurmalion thai you are asked to provide on tt�is app8ca6on is classified by State law as eiltier <br /> private or confidential. Privete date is iniormation which generally carviot be given to!he pubGt but can be given to ihe subject <br /> o!the data. Cor�fidenGal data is irrfmmation which generalty cannoE be given to either the public or the subject oi the dala. Our <br /> purpose and interoded use of lhls informaGon is to annuaRy update our reoords and recads of other gov�nmenbl agenaes <br /> requi�ed by law. If you r+efuse la supply the informatien,the appGcafion may not be issued. <br /> • Agreas that in the Qvent that westher or ott�c�ditions preveM the aompl�ion oi an as-bullt sinvay at ti+e tln�e the <br /> Cer�e of Occupsn�yr K nequ�sted,a ternporary CertHir.ate ot OccupaacY re�►be i�sued upoa neNpt af a:10,000 <br /> escrow Eo�sura complet�on of the as-b�lt sw�wy and aN sifR improvanisnts. <br /> ApplicanYs Signature: Date: <br /> �Owrter's Signature: ' + Date: a� ��/a <br /> , <br /> � <br /> Packet Last flpdaled: 03-O6-2D12 <br /> -22- <br />