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{ . . i r . STRUCTURE INFORMATION: 1.`St�ucture Dimensions 1.Structure Dimensfons(continued) 2.Type of Conatruction ' a.Length(ft.)= Number of bedrooms= ,�Wood/Frame b.Widih(ft.)= Number of garage stalls: ❑Masonry iAreas in sauare(eet Attached= ❑Metal ❑Pols Bidg. I c.Basement= Detached= d.1'�Story = ❑ICF � e.2nd Story= ❑On-site Prefab f, %x Story = : ❑Off-sfte Prefab ' ❑Other(please specify): g.Total Area= _ � REQUIRED SUBMITTALS: All of the information must be submitted in order for bur a , licakion to be ro�esS�d: No� ; Enclosed A licabte O Permit: lisation � Pro osed Buildin Plans � ' MN Stete Ener Cade Calcufations and Meohanical Code Re uirements Form � Surve meetin ell re uirbments � StOrmWate[Pollutlon Prevention Plan + � Hardcover Calc I�tion s' 5e tic 5 tem Site Evaluation Re art fl Acce'ss PermiF � Wedgnd Buffer im rovement Plan ' � ' En ineered Plans forRetainin 1Nalls 4 feet or above � Minnehaha Creek Watershed District Permft s � 0 Plan ReView Fee � n Appllcation Escrow&Agreement ; � - � � Other: i � APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all informatlon required or requested by the Building Department; ^ � • Agrees to pay the Clty of Orono for engineering consultant review costs ln excess of a500; • CerUfles that the Information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that th y i are soleiy responsible for submittfng a complete appiication being aware that upon failure to do so,the staff has no alternati � but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; � • Under�tartds soma or�II of the intormauon thatyou are asked to provide on this application is classiflep by State law as elthe ' prlvqte or confldenHal: 'Private data Is Informatio.n whicli generally cannot be given#o the pubtic but can be glven to the subjec of the data. Gonhdsntial data is informetion which gene�ally cannot be gtven to g(iher the publfc�r the subJect of the data. :pu purpose and tntsnde.d use qf thls in[ormatlo�i Ts to annuaUy update our records and record�of other govammenkal agencie required hy iaw. If you�refuse to supply fhe.informpfich.,the spplicatioh may�iot be tssued. • Agraes that in the event that weather or other eonditiona prevent the completion of an as•built survey at the time th Certiflcate oi Oecupancy ts roquested,a temporary Gertfficate of Occupaney may be issued upon recelpt of a 510,000 escrow to ensure completton of the as-built survey and all site improvements. Applicant's Signature: Date: 2�3 ^ j � i Owner's Signature: Date: �✓��`r7� i 1