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Oct 08 15 05:04p All Around 8004198422 p.2 Y � �STRUCTURE INFORMATION: � 1. Structure Dimensions 1.Structure Dimensions (continued) 2.'Fype of Construction a. Length(ft.j= Number of bedrooms= ❑Wood!Frame b.Width {ft.)= Number of garage stalls: ❑ Masonry � Areas in square feet Attached = � ❑ P�letal ❑ Pale Sidg. c.Basement= Detached= ❑ ICF d. 1"'Story = ❑On-site Prefab e, 2"`Story= I ❑ Off-sile Prefab f. '/Story = i ❑Other(please specifyj: g_Total Area= I REQUIRED SU�iN1177ALS: All of the information must be submitted in order for your application to be processed: t�€ot _.._.__--.---_- Enclosed A licabie ❑ ❑ Perm't P,pplication __.—__. .�.____ __ ❑ ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Ca{culations and Mechanical Gode Re uirements Form ❑ ❑ Surve meetin all re uirements) ..__.�_._—_ . _ ❑ ❑ Stormwater Pollution Prevention Plan ❑ 0 Hardcover Calculationjsj - —.__. ..____---------- ❑ O Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit ❑ ❑ Wetland BGffer Improvement Plan -------- . . _ _ ❑ ❑ En ineered Plans for Retainin V'JalEs 4 feei or above ❑ ❑ Minnehaha Creek Watersned Disirict Permit s ❑ fl Ptan Review Fee ❑ 0 ApplicaEior Escrow&Agreement Q � Other: -- - — -- - - ----- ------ APPLICANT/OWNER ACKNOWLEDGEMEN7: • Agrees to provide all information required or requested by the Build'mg Department; • Agrees to pay the City of Orono for engineering consultant re�iew costs in excess of$500; . Certifes that the informa:ion sUpplied is lrue and carrect to the best of his/her knowledge. The applicant recagnizes that they are solely responsible for submittiny a comple;e application being aware that upon Failure ko do so, the staff has no alternative but to reject it until ii is complete: � Acknowledges the Escro�v Agreement is compteted and signed; • Understands some or all of the information that you are asked to provide on this applicaiion is�lassified by State law as either i private or confidential. Privale data is information �vhich generally cannot be giwen to the public but can be given to the subject ' af the data. Confdential data is iniorma#ion which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of thi5 information is to annually update our records and records of oiher governmental agencies required by law. If you refuse to supply the information,the application may not be issued. . Agrees that in the event that weather or other conditians prevent the completion of an as-built survey at the tirne the Certificate of Occupancy is requesfed,a temporary Certificate of Occupancy may be issued upon receipt of a $'#0.004 escrow to ertsure completion of the as-built survey anci all site improvements. ApplicanYs Signature: date: �d` �` 1 ,� ,_ Owner's Signature: Date: