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� , STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structute Dimensions(cartinued) 2.Type of Gonstruction a. Length(ft.)= �� Number of bedrooms=_�,� �]Wood/Frame b.Width(ft.)= /� Number of garage stalls: ❑Masonry Areas in sauare feet Attached=_,� ❑Metai c. Basement= �L Detached= ❑ Pole Bldg. ❑ ICF d. 1 B'Story = �_ e 2nd StOry= � ❑On-site Prefab f. %z Story = (�r 'L 9 ❑ Off-site Prefab ❑Other(please specify): g.Total Area= _��/"� REQUIRED SUBMITTALS: AI! of the information must be submitted in order for your application to be processed: Not Enclosed Iicabls 0 ❑ Buildin Permit Escrow A reement and Fees ❑ � Plan Review Fee ❑ � Com leted lic�tion Form ❑ ❑ Pro c�sed Buildin Plans—2 full size sets,to scale and 1 reduoed 11 x 77 or 8'/z x 11 set ❑ O Minnesota State Ene Code Ca�ulations and Mechanical Code Re uirements ❑ ❑ Surve —2 full size,to scale meetin ALL surve r uiremeMs ❑ ❑ Hardcover Calculations 0 ❑ Se tic S tem Certification ❑ 0 Minnehaha Creek Watershed Distriet(MCWD)Permit or Documentation from MCWD statin no ermi#is uired ❑ O Landsca e Walls and/or Retainin Wall Plans ❑ ❑ Stormwater Pollution Preverrtion Plan SWPPP ❑ O Access Permit ❑ ❑ Data Privacy Advisory Form APPLICANT/OVUNER ACKNOWLEDGEMENT: • Agrees to provide all information fequired or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant review casts in excess of 5500; • Certifies that the information supplied is true and correct to the best of hisR�er knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has na atternatnre but to reject it until it is complete; • Acknowledges the Escrqw Agreement is completed and signed; � Understands some or all of the information that you are asked to provide on this applicaUon is ctassified by State law as either private or confidential. Private data is information which generally cannot be given tn the public but can be given to the subjed of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and irrtended use of this information is to annually update our rec�ords and records of other govemmeAtal agencies required by law. If you re#use to supply the information,the appliqtion may not be issued. � c��$'�:i11��6Hs�`��f��'�Da'��1,�. � � �� ry � "`�' r3�- �e � = r ,r.� ,. x. . � �, , ��'�I�{�� '� � � I�/�� ,,"� f 3".' ,h �: .��_ .._. .� � . � . „ .r Y�.�..��#.�,. .. .. . .: . ,. .,...,..,� .....,w . ..._.. :.: . J'_....._.-_ ..�. .. . . . ..,,.,....,:._ _ ..,......2 Ap IicanYs Si nature: ~ ' � D ��/S— /,,,� N 9 ate: Owner's Signature: Date: Last Updated: January 2095