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r . <br /> STRUCTURE INFORMATION: <br /> I 7.Structure Dimensions I 1.Structure Dimensior�a(corttinued! 1 2.Tvoe of Construction <br /> � <br /> � a. �engcn�t[.�= 1-� r i numoer or oedrooms= <br /> I f�l Wood!Fr�ne <br /> I b.VVfidih!ft.)= � i Number of aaraae stalls: I t]Masonry <br /> 1 Areas in sauate fieet i f�ttaci�ed= � ❑Met29 <br /> • { {�Poie$Edg. <br /> I c.Baaemer�t� i �e[ached= 1 �1 iCF <br /> i d. 1't Story = ! <br /> I ❑On-site PreFab <br /> I e.2`�'�Story= 1 <br /> I C��site Prefab i <br /> ( f. %:Story = <br /> � ❑Othe�(p�eaSe Spedty?: <br /> � g.7otaf Area= I <br /> REQUIRED SUBMITTALS: <br /> Alt o#the in�ormation must be submitted in order for vour anpiication to be�rocessed: <br /> ar� � . <br /> � s <br /> i Enciosed i �w�iicacie i <br /> I ❑ I ❑ f Permit Aonlipi�on <br /> ❑ I p I Pronosed Buddina Plans <br /> I ❑ i �- I MN State Eneroy Code Calculations and A7lechanicai Cade Reauiremerns Form <br /> u i u j aun►ey�meetinq aii requiremenisj <br /> i � i u i �7ormwater roiiution►-reveniion Yian <br /> ! ❑ � ❑ i Har�cover Caicuiationis� <br /> ❑ I O I Seatic Svstem Site Evaluation Report <br /> i ❑ i u i iiccess'rermit <br /> u i u I Wetland Buffer Improvemer�t Plan <br /> I � � ❑ I Engineered Plans for Retaining Wails 4 feet or abc�ve <br /> ❑ i ❑ I Minnehaha Creek Watershed District Pem�iifsi <br /> u i ❑ i Plan Review Fee <br /> I ❑ � ❑ � Application Escrow&Agreeme�t <br /> I p I ❑ I Other: <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> i • F�o�ees to provide aif informauon required or requesied by ihe Buiiding Department; i <br /> ! • Aarees to pav the City of Orono for enaineering consult�nt review costs in excess of 5500� � <br /> ! • Certifies that the information supplied is true and oorrect to the best of his/her knowledge. The aooliqnt recoanizes that thev I <br /> � are solely responsible for submitting a complete application heing aware that upon failure to do so,the staff has no altemative � <br /> i Du[[o rejeci a unai it is compieie; <br /> I • Acknowledqes the Escrow Agreement is comp(eted and signed; <br /> I • lfnderstands some or all of the information that vou are asked to orovide on this a�lication is classified bv State law as either ! <br /> I private or confiderrtial. Private data is information which generally cannot be given to the public but can be given to the subject � <br /> i of the data. Confidential data is infom�ation which generally cannot be given to either the public or the subject of the data. Our I <br /> � purpose and intended use of this information is to annually update our records and records of other govemmental agencies I <br /> � required by law. If you refuse to supply the information,the application may not be issued. � <br /> • Aarees that in the event that weather or other conditions orevent the comoletion of an as-built survev at the time the I <br /> I Gertificate of Occupancy is requested,a temporary Certlficate of Occupancy may be issued upon receipt of a 510,000 � <br /> I escrow to e�sure completion of the as-built survey and afl site imQrovements. � <br /> _���canrs�ignature: Date: <br /> �.wner'sSianature: �, �1ate: `3�a����7?/iz//S <br />