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�STRUCTURE INFORMATION: <br /> , 1.Structure Dimensions 1.Structure Dimensio�s(caHinusd) 2 Type of Conatructlon <br /> a. Le.,ocn (rc.�= �L._ n1�,.,ce�oi d.a�oo.�a= I (((���y W /F. <br /> � �J ooa ems <br /> b. VVldth (R.)= ❑M'•�^�r <br /> �i� Number oI yarapa atalls. �M <br /> aial <br /> Acc.�nea =�,T� ❑ Poi. B�a <br /> Areae In souare feet De[ech�d = V ❑'�� 0 <br /> � �On-slc• Pr�fab <br /> c. Baaem�nt= � a <br /> c �✓'}cn,[ O�.-,��e P�...b <br /> 4. ���.7[ory = �_1/,� ��her�pl�ese specl�y�: <br /> e. 2��JcorY- <br /> � <br /> f. �2 JcorY = <br /> g. To�a�A�.a= _.1�..�..L <br /> REQUIRED SUBMITTALS: <br /> A�� ofthe information must be submitted in orderfor your epplication [o be processetl. <br /> Not <br /> Enclosed A licable <br /> ❑ Pe�m�t Appli<atfon <br /> � � P�ocoesa Boue��e Pia�� <br /> ,�� MN S�a�e E., Code Ce����a��o.,, e.,a Ma��..,��e�Coaa R.q„��.me.,t, Fa�m <br /> � 5��„Qy e��.,s a���eq„��ame�« <br /> ❑ S�a.mwa�e�Po���t�o„ P�. ���o., P�. <br /> ❑ H.�d�o„e�Ca��.,�a��o., s <br /> � SePt�� 5,..�em S��. E„a�,.a��o„ R.Pon <br /> 0 ,�' A«o.s Pa�m�t <br /> � �' W.��a„a B.,,..�Impro eme„�P�a., <br /> � � E„fl��..�ed P�e,,,.a.Re�a����9 We,,, 4..e�o�abo,,. <br /> � P�a„ RB„�ew Fee <br /> ❑ O O�he� <br /> APPLICAWT ACKNOWLEDGEMENT: <br /> � /lgrees to provlde all Informatlon re r <br /> qulreA o requested byihe BuilOing �epertme�C; <br /> • Agrees to pay fhe Cit�r of Orono for engineering cor�uHarrt review cosFs in excess of;500; <br /> � l..ertlfiea thaC tha Informetlon supplisd Is true antl COrr'sCi to�he besi of hls/har knowledgs. The applf�ant feCognlZes CMaC ihey <br /> are Soiely reaponalbla for eubmltting e compieta epplicacfon bsing awer• that u0on fallur� [o do so, ih• 3xaff hes no alternaGve <br /> but co rejact It unt11 ic ty complate, <br /> � /lcknowledgas the Ezerow Agrsemani Is completed •nd signed; <br /> � UnOerstantls some or ell ofCh6 informe[1011 [hat yoU er'e eske0 fo proVitle on this applieeUon Is Cisssifietl by Jte[B leW es eithe!' <br /> private or confiden[lal. Privs2e dete Is Informailon whlch ganerally canno[b• glv�n io th• pubtlt buc�en be givon to ths subJeci <br /> ofChe [fata. Confldential da[a Is Informa2lon whlch genarally cennot G• giv�11 to althercha publlc orth• subJectofths tleia. �ur <br /> purpose and IntenOad usa of thie InformaUon Is io annuelly updet� our reeoras ana raeorCa of ochar govarnmental agencl�a <br /> rsqulretl by laW. �!you r�fuse to supply[he Infol'metlon.Cha applicaclon may no[ Da issuo0. <br /> • Agnees that in tfie event tbat weather or Mher conditions preveM the completiO�of an as-built survey at the ttme the <br /> Certlficate of Occupancy is requssted,a ten►poiary Certificate of pc�upancy may����n��t of a i10,000 <br /> escrow to ensure completion of the as-built survey and all sibe improvert�ents, <br /> ApPliqnfs Signature: � �/ �� �' ' �1 <br /> D,te: <br /> Lqe[Updacetl: 4IZ�ZO�� <br /> - 20- <br />