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STRUCTURE lNFORMATION: <br /> 1.Structure Dimensions 1.3tructure Dimenslons(coritinued) 2 Type of Constructlon <br /> a.Length(ft.)=. /� Number of bedrooms= <br /> ❑Wood!Frame <br /> b.Width(ft.}= �, Number of garage stails: ❑Masonry <br /> Areas in sc�uare feet Attached= ❑Metal <br /> ❑Pole Bldg, <br /> c. Basement= Detached= ❑ICF <br /> d. 1�Story = ❑On•site Prefab <br /> e.2"�Story= ❑Off-site Prefab <br /> f. '�Story = ❑pther(please spedfy): <br /> g.Total Area= <br /> REQUIRED SUBMITTAL3: <br /> All of the information must be submitted in order for our a lication to be rocessed: <br /> Not <br /> Enclos A Icable <br /> 0 Permit iication <br /> ❑ Pro d BulEdin Plans <br /> ❑ MN State Ener Code Galculadons and Mechanical Code Re airements Form <br /> ❑ 5urve meetin all re uirements <br /> C7 Stonnwater Pollution Preventlon Plan <br /> ❑ Hardcover Calculatlon s <br /> ❑ Se tic S stem Slte Evaluatlon Re rt <br /> ❑ Acc�ss Permit <br /> ❑ Wetiand Buffer Im rovemeM Plan <br /> ❑ En ineered Plans for Retainln Walls 4 feet or above <br /> 0 Plan fteview Fee <br /> O O Other: <br /> APpLICANTlOWNER ACKN4WLEDGEMENT: <br /> • Agrees to provide all information requir�d or requested by the 6uliding Department; <br /> . Agrees to pay the Gity oi Orono for englneertng consultar�t revlew costs In excess of$500; <br /> • CerEifies that the information supplied is true and correct to tt�e best of hlsJher knowledge. The applicant recognlzes thet they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reJect it until it is camplete; <br /> • Acknowledges the Escruw Agreement ia completed end signed; <br /> • Understands sorne or all of the inforrnation ihat you are asked to provide on this appllcation is classifiad by Stata law as either <br /> pr(vate or confidential. Privete data is informaUon which generally cannot be g}ven to the public but can be given to the subJect <br /> of the data. Confldentfal data ts information which generally cannot be given to either the publlc or the subject of the data. Our <br /> purpose and intended use of this informstion Is to annually update our records and records of other govemmental agenaes <br /> required by law. If you refuse to supply the information,the applicatfon may not be issued. <br /> • Agrees that in 1he evant fhat weather or o�er condldona p ent the�ompletion oT an as-buflt survey at the tlms the <br /> Certiflcate of OccupanCy is requested,a temporary Ce ate of Occupancy may be lssued upon receipt of a 570,006 <br /> escrow to ensure completion of the as-bulit sunrey ali slte Improvements. <br /> Applicant's Signature: Qate: /����.sL-- �1 a—�'� <br /> Owner's Signature; i""`' �� Date: <br /> Pecket Last Updated: 03-06-2012 <br /> -22- <br />