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STRUCTURE INFORMATION: <br /> 1.3tructure Dimensions 1.Structure Dtmenslons(contlnued) 2.Type oT Constructlon <br /> e. Length(ft.)= Number of bedrooms= <br /> ❑Wood/Frame <br /> b.Width(ft)= Number of garage stalls ❑Masonry <br /> Areas In sauare feet Altached= ❑Metal <br /> ❑Pole Bldg <br /> c.Basement= _ Detached= ❑ICF <br /> d. 15�Story = <br /> ❑On-site Prefab <br /> e. 2rO Story= ❑Off-site Pr�efab <br /> f. i4 Story = <br /> ❑Other(please specify).______.___ <br /> g.Total Area= <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for our application to be processed: <br /> --- __ _ --- <br /> Not _. ..__ <br /> Enclosed Ap Ilp cable _ ___._._ __._._______.. _. <br /> O Permit A Ilcation <br /> — -- ----- -._ ___--- <br /> __ __. �----_____—._ ----- <br /> ❑ Proposed Building Plans <br /> '0. � O� � MN State Energy Code CalculaUons end Mechanical Code R ufroments Fortn <br /> __ _ <br /> _. <br /> '6 O Surve meetin all requtrements) ____ <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> 'fl. _ O � Hardcover Ca�ulation s� <br /> ❑ O Se Uc S stem Site Evaluation Repai ��_ ____, <br /> O � O - -- Access Permit <br /> � O WeUand Buffer I rovement Plan <br /> O O En ineered Plans tor Retafnin Walls 4 feet or above <br /> -- ---- _ _ <br /> ❑ ❑ Minnehaha Creek Watershed Distrfct Permi s <br /> ❑ O Plan Review Fee <br /> ❑ � Application Escrow 8�Agreemanl <br /> -------- --.__---- _______ <br /> _. o o ___ otne� <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> • Agrees to provtde all(nfortnation required or requested by the Bullding Depertmenk <br /> • Agrees to pay the Clty of Orono for engineering consultant revtew costs in exceas of;500; <br /> . CerAfies thal the intormatian supplied is true and correc!to the best ot his/her knowledpe. The applicant recognizes Ihal they <br /> are solely reaponslble for submifling e complete appi(cation being awaro fhat upon failure lo do eo,the staff hes no alternative <br /> but lo rejecl it unlfl It is complete; <br /> • Acknowledges lhe Escrow Agreement Is completed end signed; <br /> • Understands some or all ot the Information that you ere esked to pmvida on lhla ep�lcalion Is clessf8ed by State law as eflher <br /> pdvate or confidendal. Private data is Information whfch generally cennot be piven to the publio but can be given fo the subJecl <br /> of the data. Confldentfal data(s iniormation wh�h generally cannot be given to eilher ihe publfc or the subJect of the data Our <br /> purpose and inlended use o(thls informaUon Is to annually update our records and recorda of othar govemmental apendea <br /> required by law. If you retuse to supply the Infortnalfon,ihe applicalion may not be Issued <br /> . Agrees that in the event that weather or other condltions prevent the completion of�n as-built aurvey at the Bms th� <br /> Certiflcate oi Occupancy is requested,a temporary Certiflcete of Occupancy may be issued upon recelpt of a:10,000 <br /> escrow to ensure completton of the as-built survey and all site tmprovements. <br /> ----- ---_ ' <br /> r � �,/ ' � ���{ ��'�'�"�' - <br /> ApplicanYs Signature: �� ��iL� ` � _ � ' Date: � a�'��`� � <br /> Owner's Signature: Date: � I�J ° I �- <br />