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�+m+t A 3At'5�+�@.+£1'Sn. SS!! !�+��L�'.b1S"1 S('!✓a6. <br /> � t�.Struc�ure Dimenalons f.Str�lcture Dlmenslons{rontinued) Z.Type ot Construcdoh �, �G <br /> � r s.l_ength fft}= �� tJumber of Dadrooms= .r`> � <br /> �Wood/�rame <br /> b.Width�ft-)= q�" Number ot garage stalls: d Ma�oqky ��CG U��{�l C'C� �(`��`,� � <br /> Areas tt�sauare}eet ' Attached=� ❑���^r f i /` . <br /> �► l�O�l�, <br /> c.B a s e m e rn= 3d a ❑Pot�eldg. � ✓�� <br /> � r�t�n�� p��c�� ���`Fie�t —Z0�`� �i <br /> d,s�sto�r � <br /> p o�r$►re pretab <br /> e.2^a Sio►Y= � <br /> f. 1h�Story �_ .a ❑-��j -s�ls Prefab <br /> C�q�fi�►4ptease.specffyl; <br /> g.Tatal,f�ea= � , f <br /> �EQur�eo sue�tirra�s: <br /> Ali of the information must be submitied in atdsr for our ii�atic�rt to be rocessed: <br /> Not _ _ „ _. _ .._ _ <br /> Enclasexf A licabie <br /> Cl C7 Buik#in f'errn��ow A reemeni and Fees <br /> � ❑ Pien Review Fe� <br /> D ❑ Ca ieted R licafion Form <br /> Q 0 Pra osed B�ikiin Plans—2 full si�e s�t ta scais and i reduced 11 x 17 or 8�h x 11 set <br /> � � IiAinnesota State�nerg Code Calaularions and Mechanical Got3e R u#remsr�ts <br /> ❑ ❑ Sunre —2 foU size,ta scaie(mee}' ALt su,nre r uiremertts} <br /> �► ❑ Hat�cover Catcuiatians <br /> L1 ❑ Se Elt em Gertii3catian <br /> � a Minnehaha��ek Watershed Disfrid{NIG4VDy Permit or � <br /> Oocument�tion i�orri MCV11D sYatin ho imii is re uired <br /> 0 l.andsca Wails qridtor Retaini YVaf!Plartis <br /> L] ❑ Starmwater Poflution Prevention Plan�SWPPP) <br /> CI Q A�ess Psrmit <br /> ❑ ❑ Data Pr �dviso Fcatm <br /> APRLfCANT/OWNER ACKN�INLEDGEMENT: <br /> � Aflrees to provida a!!irdormation r+�quired or requasled b�r the Bulldinp deparUnettt; <br /> • Agrees fo pay ths City of Orono!nr engineering aonx�itent revMrw costa In exetss of�600; <br /> s �ertifies that the ir�formation suppAed is true and correct to the baet oi hislher#mowleclge_ The appBc�rtt recoQnaes thatt?fey are <br /> solely�esponsible fur submitdng a complate aRPlicatign bein9'�vu�ihai upvn failure to do ap,the stsff has no a�tetnative but to <br /> r�ject�t ur�ti!!t Is camplete: <br /> • A�knowledgas the Escrow Agreemen#is cqmpfeted a[x!signed; <br /> • Und�rstands svme or aN of the information thai you are asiced t�,prtsvide on thie "appNcatian fs cta�iti�d by State lew as eitlter <br /> private or eonfidei�tiai. Privata data is infarmation which generallytzannot be given to the public bu!can k�e g+ven to the subject of <br /> the data. Confidantial data is intormaiion which�sneralfy cannot be gi�an to either the pubilc ot the sutr�sd ot the data. Our <br /> purpose and intencled usa ol thJs informatian fa to.annual4y update our records and tscorcls df other�ovemmerrta{ agencies <br /> required by law. If you re#use to supply Fhe iniormation,the apptication may not ba issued. <br /> • �diraea�it!n Ehe avejit:that we��her nr Qth�t c:ant�Eli�nR preYe�tha co.mplatlory ot an as-bu�(t u�tvey ac�he Hrt+s� <br /> C�riif}�ate dt�G7iricupa�3c�r.ls:r�gefe�ted.a•ts,Itr�rtiraFy Ccrfifkata tft;Ot�sup�n�Y������+1�pc?n recet,pi at a S1a.�Ob <br /> �.f�+w!a ens��:wif��,Hkt�pn vf�tf►a�s�4ui1L'�uivey an¢$N�sAte.Nu�pve�»e�+ts; <br /> APplicarYt�s Signature:_. Qate: �� '� "� <br /> Uwner's Signature: /�� t)ate: _ �a �1"7 � <br /> Pacx�riasru�ararear,au9ust2are <br /> Page a� <br /> f <br />