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� , A <br /> ✓ ' � <br /> City of Orono �� <br /> Building Permit Application r <br /> � <br /> for a Swimming Pool ��► �� <br /> Mailing Address: Permit number: ��1�-D//3 O <br /> �,�,��. PO Box 66 <br /> O �� � Crystal Bay, MN 55323-0066 Date received: ��"'lP '�02-- <br /> �'�'��;,,, Received by: /�� <br /> a, ���,,;, ,, Street Address: <br /> �',�, �.. '° 'BJ� �ti�' 2750 Kelley Parkway Plan review fee: J� , <br /> l.yg�SHo�,� Orono, MN 55356 a���_����g <br /> Total F e: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �,(; <br /> This application form must be completed in full and all required informa on must be submitt . <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2p���'��� ��--��� <br /> CONTRACTOR/ LICANT INF ATION: <br /> Name: ��r��nti,s���� SQR <br /> State License# � _ Expiration Date: <br /> Phone: ��5 1 ��l �-� 4t� Fax: �(v��7�3�-�.3�2 <br /> Address �,G � , Cit : • � ►,�.� ZIP: '� �t2 r <br /> Contact Person: ' o .- - Contact's phone nu (�;.,5-i S�-. '`�4c> <br /> Email �, ,-..� .�' n� � C�. � Applicant is: ontractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: ^ z E <br /> Phone (day): �-�q- <br /> Mailing Address: �qqr� . ��-+; , ,,,��—T'�.�-i� �''�r��} �vv� ZIP:J��S�v <br /> Email and/or Fax <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: <br /> Email <br /> PROJECT INFORMATION: y r ,, +���� �(1v`� P <br /> 1. Pool Dimensions: 4.Accessor to: � /!�� C osal & <br /> V�(� �Iy <br /> �X �1.�G feet F�Single Family �r <br /> 1`-' '\�1�'_' <br /> 2. Heated? ❑ Multiple Family/Cor <br /> � yes ❑ no � Public � ier <br /> 3. Excavated materials will be: ❑ Commercial /?�� `� " " ;r <br /> ❑ Industrial �� l <br /> � removed from site � II <br /> ❑ used on site ❑ Ot her. (speci f y) V^�„ „ „ 1 C'�.�'`�` � <br /> � � <br /> ❑ Other: (specify) � . ,�,� <br /> �V3 J�y <br /> Total Cubic Yards � <br /> Estimated Construction Valuation $ ��r,�� <br /> LastUpdated: 10/28/2010 <br /> - 7- <br />