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, � , <br /> STRUCTURE INPORMAT'I�N: <br /> 1.Structure Dimenaions 1.St+vature imer►sions(corrtinuedi Z yR,e o�Consiructton <br /> � <br /> a.Length(ft•Y' �� fVumhe�'of beGrvoma� <br /> 3 ❑wood��►a,�,e � <br /> b,Width fft.� _ Number af garaae staflg; �"'i MaSrynn, t <br /> iALeas.in squar�feet � Attached= � ❑a►etal <br /> u Role Bidg. <br /> c. Basemenr- Derached= <br /> d. 1'�Story = ❑ICF <br /> �Ort�site Prefab <br /> �.2"�5tory= <br /> f. 'rG Story = ❑�ff site P�fab <br /> g.Total Area= ❑Other{please speclty.)- <br /> REQUfREO SU6MlT'fAL,S: <br /> Ali of the infomiation must be submitted in order for yqur a licatiort fio be processed: <br /> Not <br /> EnclbseQ A (icable <br /> 4 0 Permit A Mcation <br /> � � I�ra osed Buildi P1ans <br /> ❑ �nN State En Gode Ca�ulativns and Mechanical Code R uirements Fortn <br /> O Sunre meetin aA air�mants <br /> Q � Sturm�rater Poitutian Preverttion PI�n <br /> O � Hatdcover Calculation g <br /> 0 � Se tic S tem Site Evatua�on R ort <br /> O 0 Acc�ss PeRnit <br /> � 0 Wetla�d BufF2r 1m rovernerit p}an <br /> En ineered Plans fvr Retaini WaUs a teet or above <br /> ❑ � Min haha Creeic Wabershed District Perm{t s <br /> Q ❑ Plan Review Fee <br /> � �tner, <br /> APPLICANTIOWM�R ACMCNOWR.EDGEMENT; <br /> • Agrees to prvvide all information required or�quested Dq the Hurld'mg Departrnent; <br /> • Ag�es to pay the City of orono!or engineeNng corrsull�nt r+�vlew eests In excess of�500; <br /> • Certiflp�g that tf�2 in�ormafion suppiied is true snd comect tp tlte best pf his/her knqwledge. Tlte app�jcant�ogmzes that they <br /> are soiely resportsible for Submitdng a complete applicatian being aware that upon i�iiure to do so,the statF has no aldarnative <br /> but io rej¢d it unpl it is complete; <br /> • Acknowledges the E9Craw Agr�eement is compteted and sigr►ed: <br /> • Understands some or all oi the infqrmatlon t�at you are ask�a to prvvlcfe nn this applftx�on is ctassified by State law ss edher <br /> private vr conflderttisl. Private data is iMarmation which gerietally carsnat be given to tt1e public but can be g{ven to the subjed <br /> of the data. Confidential data Is infunnation whicl►ge�eralty canno}be given to eiU►er the public dr me subject of the aata, Our <br /> purpose antl irrtended use of this i�ortnation is tv anrn,ally updat� our recbrds and r�cards of other governmeMat agencies <br /> reRuir+�d dy iaw, if you�fisse to supply the infarsr�Non,the appl9c;atlon may nat be issuetl. <br /> - /�grecs thet in the event fhst rre�atber or a�ther condt�orrs prever�t!he completlon of an as-buNt survey at�te time the <br /> Cer�ticate af Clcoupancy is reques�ed,a tpn,p�rary CeNNr.ab�af Occupancy�r�ay be lssued vpon necelpt of a iiD,M10 <br /> eserow!o ensvre aomp{eNon of�e as-buitt survey anQ aii s�6e improrements. <br /> APP�icant's Signature: Date: _ 7'"' �� '� �� <br /> (h�rner's Signature: ��te: <br /> Pac��t 1.85t�Jpdated� O�I'►9/Zt113 <br /> Pb,qe 23 of 23 <br />