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STRUCTURE INFORMATION: � � Z.T e ot ConstrucHon <br /> 1.Structure Dimensions 1.Structure Dimensions continued YP <br /> L'` �i � Number of bedrooms= ❑Wood!Frame <br /> a.lenglh(H.)= __�T ❑Masonry <br /> b.Widlh(fl.)= ` Number oi garage stalls. �Metal <br /> Areas in sauere feel <br /> Atlached=__ �pole Bldg. <br /> Delached=___ ❑IGF <br /> c.Basemenl= �On-sile Prefab � �'�'�- <br /> d.1'�Slory = �p}f-site Prafab �� <br /> e.2"d Slory= ❑Other(Pleasa speciry)� 'r � <br /> f. h Slory = <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information Nott be submitted in order for our a lication to be rocesse : <br /> Enclos A Ilcable <br /> p Permil A lication <br /> p Pro osed Buiklin Plans <br /> � ❑ MN State Ene Code Calculations and Mechanical Code Re uireme��9 a�" <br /> � p Surva meetin ell re uirements <br /> � p Stortrn+ater Pollulion Preven6on P�an <br /> � p HardcoverCalwlation s <br /> � p Se lic S stem Site Evaluetion Re ort <br /> � p Access Pertnit <br /> � p Welland Buftar Im rovement Plan <br /> � p En ineered Pians for Relainin Walis 4 feet or above <br /> � ❑ Minnehaha Creek Watershed District Perm�l s <br /> � ❑ Plan Review Fee <br /> � qpplicallon Escrow&Agreement <br /> ❑ <br /> � ❑ Othec <br /> qppLICANTIOWNER ACKNOWLEDGEMENT: <br /> . Agrees to provide all information required or requested by lhe Building Deparlment; <br /> . Agrees to pay ihs City of Orono for eng�neering consultant revlew costs in excess of 5500; ���anl recognizes that they <br /> licat'on being aware that upon tailure to do so,the staff has no altemalive <br /> Cerlifies lhal the in(ormation supplied is We and correct to lhe besl of hislher knowledge. e app <br /> • are soleiy responsible For su e eilUng a complela app <br /> but lo reject it unGl it Is comp leted and signed, <br /> . Acknowladges lhe Esuow A9�eement is comP �i�tion is classified by S1ale law as eilher <br /> Understands some or ell of lhe InfortnaGon Ihet you are asked to provid Ven`I e,her lhe public w the subject of lhe dala. �� <br /> • privale or confidenlial. Private dela is iniormation which generally ca�not be given lo ihe public bu���bovemmenlah agenGees <br /> ate our records and records of other g <br /> of the data. Confidenlial data is in(ortnation which generally cannot be 9 <br /> purposa and inlended use of lhls infortn 8��1�tortnation,thellapP�Calion may not be issued. <br /> required by lew. If you refuse lo suPP Y <br /> nia CeRiflcate of Occupancy may be issued upon receipt ot a 510.000 <br /> , qyrees that fn the event that weather or other conditions prevent the completion of an as-built survey at the time e <br /> Gertifieate of Occupancy�s reQuested,a temP �nd all site impro�ementa. <br /> escrow to ensure completion of the as�built survey <br /> C.�_.�,,.G� Date'. " ��� � �I <br /> Applicant's Signature: � � � � �i'/ <br /> � Dale: �• <br /> Owner's Signa ur .___� <br />