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___ . ____ _.,�._ _ _ _ --� <br /> $TRUCTURE INFORMATION: <br /> 1.Structure Dimensiona 1.Structure Dimenslons(continued) 2.Type of Construction <br /> a.Lenglh(R.)= �� iVumber M bedrooma=� <br /> [�Wood l Frame <br /> b.W Idth(ft.r- �j v� Number oi garage stalls: Ll�aeo+,ry <br /> Areas in eauare teet � p,���� � , ❑Metal <br /> ❑Pole Bldg. <br /> c.Basement= /O Oetached= ❑ICF <br /> d. 1'�Story = �/�� <br /> � � ❑On-site Prefab <br /> ! e.2n°3tory= ❑Off-site Prefab <br /> �i f. %:5�' _ _^..__a_ ❑Olher(please apecllY)� _ <br /> g.Total Area= <br /> ' -- - <br /> REQUIRED SUBAAITTALS: � <br /> All of the infarmatlon must be submitted in order for your application to be processed; � <br /> - --._..._._— _ ___ ___ <br /> Not <br /> Enc� Applicabla <br /> - - - - <br /> O Perm(t Appllcation _.__�__ <br /> - —.- _._ <br /> ❑ __� Proposed 6uildina Plens --- __--.- <br /> l7 MN State Energy Code Ca�ulatlone and Mechanical Code Re ulremenls Form <br /> - - -- ---- __-__. <br /> ❑ Sww�r(meeting all raquirements) � ___ _ <br /> O , Stormwater Pollutior�Preveniion Plan <br /> .. _- ________ -- <br /> ❑ Hardcover Calculatlon(s} <br /> -- - - — <br /> - ---- __--.. _--- <br /> ❑ Septic�tem Site Evaluaflon Report � <br /> -- � - - - ACcess Perrnit <br /> - - - _. _ _ _ . _ ._ <br /> ❑ Wetlend Buffer Improvement Plan <br /> __ ___ ---- -__�.,_ _ . _ - -- - -- -- --- <br /> p Engineered Plans for Retaining Walls 4 feet or abova <br /> -- - . _ <br /> ❑ Ninnehaha Creek Wetershed District Pertnit a <br /> Cl � Plan Review Fee � <br /> - - -- _ <br /> ❑ __ --_ _ _. <br /> ' Olher: <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> • Agrees to provide all informatlon requlred or requested by the Building Depardnenfi <br /> • Agrees to pay 1he City ot Orono for enginee�lag consultant review costs ln excess ot;500; <br /> • Certlfles that the informatlon supplled Is true and correct to the best of hislher knawledge. The appllcarit recogr�zes that they ; <br /> are solely reaponsible for submit@ng a oomplete appllcaUon being aware that upon failure to da ao,the staff has no altarrmtive <br /> bt�to reject R uritil it is complete; <br /> • Acknowledgas the Escrow Agreement is completed and a{gned; <br /> • Understands some or all of Hie inbrmation that you are asked to provide on this application is dassifted by State law as sllher <br /> private or co►rfidentlal. Privete date Is informatfon whlch garterally carmot be given to fhe publlc but can be given to Ihe subject <br /> of the data. CaMidendal data fs InformaUon whlch generally can�ot be given to elfher the publlc or the subject af the data. Ou� <br /> purpose and Intended use of thlg informadon is to annually update our records and records of other goverrpneMal agencles <br /> required 6y law. If you refuse to supply tha information,the applicatlon may not be Issued. <br /> • Agreas that In the event that weather or other condltlons prevartt tlte comple6on of an as-bullt survey at ths tNne the ; <br /> CerWlcab of Oacupaney Is requested,a temponrry Certlfioate of Occupancy rnay be fssuad upon receipt ot a 510,008 � <br /> eserow to snsure completlon of the as-butlt survey and all sl4e Improveme�s. <br /> ApplicanYs Signature: Oate: � <br /> Owner's Signature: Date: � 5 <br /> PacketLeat(lAdated.• 04/f9/2093 � "�`-� <br /> lPege 23 of 23 <br />