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STRUCTURE INFORMATION: <br /> 1.Structure;Dimensions 1,Structure Dimensions(continued) 2.Type of Construction <br /> a.Length(ft.)= Number of bedrooms= ©'Wood/Frame_ <br /> EIMasonry` <br /> b.Width (ft.)= Number of garage stalls: ,Metal <br /> Attached= [}Pole Bldg. <br /> Areas in square feet Detached El ICF <br /> (]On-site Prefab <br /> c. Basement= Cl Off4te Prefab' <br /> d. 18i-;Story ❑Other(please specify): <br /> e.2"d Story: <br /> f. '/Story = <br /> g.Total Area <br /> REQUIRED SUBMITTALS: <br /> All of the information must be:submitted in order for your application:to:be`p�ocessed: <br /> Not <br /> Enclosed A lcable <br /> ❑ <br /> P17 <br /> ermit'A "lication. <br /> d. Proposed Building,'Plans <br /> ❑ MN State Ener Code CalcUlat16ns Ar1Jtl'Me6hahical Code Re uirements"Form ; <br /> ❑ <br /> Survey(meeting' :all re uiientents <br /> Stormwater Pollution'Preventlon Plan <br /> Hardcover-Oalculation,s ;: <br /> Se tic S item Site,Evaluation.Re°"ort, <br /> 13 Access Permit <br /> l7 Wetland Buffer ImrovementPlai�. . <br /> C3 <br /> Engineered Plans'forRetainin Walis 4,feet or alive <br /> 1D ❑ Plan Review Fee <br /> � ❑ Other <br /> APPLICANT ACKNOWLEDGEMENT <br /> • Agrees to provide all.information required or requested by the Building Department; <br /> • Agrees to pay the City of orono for engineering consultant-review costs in excess of 600s, <br /> Certifies that the-info rmation supplietl Ir is true and correct to the best of his/h-&,knowledge Theea}�plrcant recognizes that they <br /> are solely responsible for submitting a complete application l eing,aWare:that upon failure to,- o§ "thelstafF nas no alternative <br /> but to reject it until it is complete-- <br /> • Acknowledges the Escrow Agreement is completed-an -signed, <br /> • Some or all of the information that you are asked to provide ort this app�ication=is dlass ified by State law as either:prvate ar <br /> confidential; Private data is information which generally cannot,be'given tea this public but can given to,the subjedt ofthe tlafa. <br /> Confidential tlata'is information which generally cannot be gnien to,eifher.the public or the subject of the:data. Our purpose and;,; <br /> intended use of this information is to annually update our records and reoQr f other`governmental agencies�equiretl"`by law.' <br /> if yourefuseao supply the information,the application may;notiieissued.>v : <br /> Applicant's Signature: l Q C <br /> Date: <br /> Last Updated: 9/29/2009 <br /> - 18 - <br />