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�S'��s��- ax� �� '' o c sh�,�; ��ie o s� ,, „ <br /> , � '�- � �u.sses l6 ,�ru���9, � oL <br /> Sia�� -Ja�mes <br /> a,m . <br /> STRUCTURE IN RMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> �. <br /> a. Length (ft.)= 7i?i Number of b drooms= � Wood/Frame <br /> � asonry <br /> b.Width (ft.)= ��D Number of arase stalls: Metal <br /> Attached _� ❑ Pole Bldg. <br /> Areas in square fTeet Detached - ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement= • ❑ Off-site Prefab <br /> d. 15t Story = ❑ Other(piease specify): <br /> e. 2"d Story= S�Z <br /> f. '/Story = <br /> g. Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be ubmitted in order for your application to be processed: <br /> >N.ot <br /> ,`Enclosed A licable <br /> ❑ Permit A lication <br /> � Pro osed Buildin Plans <br /> ❑ ❑ MN State Ener Code C culations and Mechanical Code R uirements Form <br /> ❑ Surve meetin all re uir ments <br /> � ❑ Stormwater Pollution Pre ntion Plan <br /> ❑ Hardcover Calculation s <br /> ❑ ❑ e tic S stem Site Eval tion Re ort <br /> � ❑ ess Permit <br /> � � d Buffer Im rove ent Plan <br /> ❑ ❑ En ineere lans for R tainin Walls 4 feet o bove <br /> � ❑ ❑ Plan Review � <br /> � ❑ Other <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Buil ' Department; <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solefy 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 complete; <br /> • Acknowledges the Escrow Agreement is completed and signed; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the pubfic but can be given to the subject of the data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> ApplicanYs Signature: Date: <br /> Last Updated: 6/22/2009 <br /> -20 - <br />