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STRUCTURE INFORMATlON: <br /> 1.3tructure Dimensioes 1.Skructure Dimensions(contlnued) 2.Type of Con�truction <br /> a.Langth(ft.)= �6 Nutnber of bedraoms= 3 �CUVood/Frame <br /> Q Masanry <br /> b.Wldth(ft.a= a�_ Plumber of garage stalls: Q Metal <br /> -- Attached=_Z-_ ❑Pole Bidg. <br /> Areas in sauare faei Detached=M� ❑!CF <br /> ❑On-site Pr�Fab <br /> c.Basement= 110� ❑�ff�ife Prefab <br /> d. 1'�Stary = �10� ❑Other(please specity):-- -- <br /> e.2ntl Story= _.�,_ <br /> f. %Story = _,_,_ <br /> g.Total Area= 2�8 <br /> REQUIRED SUBMITTAL,S: <br /> A#I of the informatian must be submitted in order for our a lication to be rocessed: <br /> Not <br /> ' Enclosed A ticatrle <br /> � Permit A ication <br /> ❑ Pro ed Buildin Plans <br /> 0 C3 MN State Ene Code Caiculations and Mechanical Code R uirements Form <br /> ❑ Surve meeti al(re uirements <br /> ❑ ❑ Stormwater Palution Prevent{on Plan <br /> ❑ ❑ Hardcover Calcuiation s <br /> ❑ CJ Se tic S stem Site Evaluation Re ort <br /> ❑ ❑ Ac.cess Pem�it <br /> ❑ ❑ Wet}and Btiffer!m vement Plan <br /> ❑ ❑ E ineered Pians for Rstainin Wails 4 feet or above <br /> C� ❑ Pian Review Fee <br /> O O Other <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agreas to provide a�l information required or requested by the Building Department; <br /> . Agrees to pay�e City of Oror►o for engineering coosultant review costs in excess of 5500; <br /> • Certifies that the informatlon supplied is true and cortect to the best of h9s/her knowledge. The spplicant recognizes that they <br /> are solely responsible for submitting a complete appiicatlon being aware that upon failure ta do so,the staff has no a{ternative <br /> but to reject it until it is complete; <br /> • Acknowledges the Escrow qgreement is campleted and signed; <br /> . Some or at! of the information thai you are asked to provide on this application is classified by State law as either private or <br /> confidentia!_ Private data is information which generally cannai be given to the pubiic but can be given to the subject of the data. <br /> Confidentia�data is informatian whicfi generally cannot be given to either the public o�tt►e subject of the data. Our purpase and <br /> intended use of this in#om�atian is to annually update our records and records of other gwemmenial agencies requireci by law. <br /> If you refuse to suppiy the infotmation,the spplication may not be issued. <br /> ApplicanYs Signature: V .(� ��Q��, Date: 1!� "�' O g <br /> Last Upttated; 8l22J2009 <br /> -2Q- <br />