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STRUCTURE INFORMATION: 1.8truoture Dimensb� 1.�tructure Dimensions(co�nued) 2.Typa of Constructlon a.Lenath(ft.)= Number of bedrooms= ❑Wood/Frame b.Width(ft.)= Number of garage stalls: ❑Masorvy Att�s in sauare feet Atfached= ❑M� ❑Pde Bldg. c.Basement= ��_ ❑ICF d 1°�Story ❑On-site Pr�ab e.2'�Story= ❑Olf-site Prefab f. 'r4 S�ory = ❑Olher(P�$P�Y)� g.TWaI Ar�= REQUIRED SUBMITTALS: All of the informaUon must be submitted in order for our a lication to be rooessed: irot EnCtOsed qca�le 0 ❑ BuiMi Permk Escrow reemeM arni Fees � O Plan Review Fee ❑ O Com eted ication Form ❑ O P Buildi Plans—2 full size sets to scale and 1 reduced 11 x 17 or 8 94 x 11 set � � MY�ne�ta State En Code Calculations and Mechartical Code R uireme� 0 � Surve —2 fuH aize,to scele ' ALL su uiremerds O ❑ Herdcover Calculations O ❑ ' S stan Cedificatlon O O Minnehaha Creek Watershed District(MCWD)Pemut or Documer�tion from MCWD sfefi no k is uired O ❑ Lendsce YValls end/w Retainin WaN Plans ❑ O Stormwater Pdlulbn PreveMion Plan SWPPP o a ,ao�r�m,�c O O Date Priva Adviso Form APPLICANT/OWNER ACKNOWLEDGEMENT: • Aprees to provide all iMortnation required or requested by the Building DepartrnenK • Agrees to pay tl�e CUy of Orono for angirreering consulFark review cosb fn excess of 5600; • Ce�es that the infortnatlon supplied ia true and correet to the best of his/her knowledpe. The applicar�t recopnizes tl�at they are sddy responside for submitting a aomplets applicetion being aware that upon faAure to do so.the staff has�o altemative but to rejed k urH�ft is complebe; • Ackrw�Medges the Escrow Agreement is oompleEed and signed; • Understands some a all of C�e infortnatbn tl�at you are asked to provide on this applicatlon�dassified by State law as either privaSe or cor�idential. Private data is irAortnation wh�h generally cannot be given to ttie public but can be piven to the subjoct of fhe data. ConfideMial data is information which penerally cannot be piven to eitlter tlie public or tM subjed of Me data. Our purpose and iMended use of this iMortnation is to annuady update our records and records of other govemmerNal agencbs required by law. M you refuse b suPp1Y the irMormation,the application may not be issued. • A9re�s that in fM avrnt tlut Ma�tliar or WMr conditlons phvMt ths camplafion M an as-0uilt wMeY at the tlmo th� CartlflC�ta of Occup�ncy N ropwslod.s l�mpoisiY C�rtllfe�b of OccuW�Y�Y ba Iptrod upon naipt ot a t10.000 acrow to waure complNbn of tM as�bWt wrwy and aN alb ImprowmNrtt. ApplicanYs Signature: Date: �.�5•� Owner's Signature: Date:q�•� Pecket Last Updeted:Aupust 2015 Pege 22