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STRUCTURE INFORMATION: 1.3tructure Dimensions 1.3tructure Dimensfons(continued) 2 Typa of Construction a.Length(ft.)= Ntxttber of bedroans= ❑Wood/Frame b.Width(ft.)= Number of garage atalts: ❑Masonry Areas in aauare feet q�q�: ❑Metel ❑Pole Bidg. c.Basemerrt= petaq�d: d. 1 p St�y = ❑ICF e.2nd Story= ❑On-site Prefab ❑Off-slte P�efab f. i4 Story = �Other(please sPe�Y)� g.Totat Areas REQUIRED SUBMITTALS: All of the information must be submitted In order for our a lication to be rocessed: Not Enclosad Icabie O � P�nit icatlon .�, O O gt�Nd p�en.q � 0 MN State Code CalCulatbns and Mec�enicai Code R �dremeMs Form O � mee� aM uirements a a Stomlwater Po1luBon Prev�endon Plan O 0 Hard�Calc�latlo a � 0 c em SRe Evaluation Re 0 0 Acoess PertMt O O Wetiand Bu(fer I rovement Plan O � ineered Plans for RetaiN Wa�s 4 feet or above O O Mirx�ehaha Creek Watershed DisMc:t Pertr�t s � � Plan Review Fee O O Appik�tion Escxotiv 8�/�reement 0 O Other: APPLICANT/OWNER ACKNOWLEDGEMENT: • Aprees to provlde all infom�ation required or requested by the Buildin9 Depar�'nerrt: • Agroes to pay the Criy ot Orono for enginoering consulbnt revia�r costs In excess oi�; • Certifies that the infortnatlon s�lied is fi�e and corred to tl�e best of his/her kno�Medge. The applicaM recbgnizes tl�at they are solely responsit�e for aubmitting a oomplete appiication being aware that upon feilure to do so, the staff has no altemative but to r+ejec�R�ti1 it is ocmpiete; • Adcnowledgea the Escro�n►�reement is oompleted and signed; • Understands aome or aq of the infortnatlon that you are asked to provide on this appHcadon is dassified by State law as either pfirate or c�onfideMiai. Pr(vate data��fom�atia�which generally cannot�gh�n to tl�e pubiic but can be given to the subJJecc:t of tlie data. CoMiderrtiel data is GrfortnaHon which generafy cannot be given to eitl�the pubBc o�the subjed of tlie data. Our purpose and irrtended use of this infortnatlon is to aru�ualy update oiu reoords and reoords of ofher govemmental aget�cies requ�ed by law. If�u refuse to supply tl�e inforrnatfon,the appllc�tion may not be�sued. • Agrees that In the eveM that weather or other condttions prevent the completton of an as-buik sunrey at the time the Certiflcate ot Occupancy is requasted�a t�mporery Certifica�of Occupancy may be issued upon receipt of a;10�000 escrowto ensure compl n of the as-built survey and all site Improvements. Applicarrt's Signature: Date: �- �� ?� OHmers Signature: Date: