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16/18/2012 04:17 9529855323 QUALITY POOLS PAGE 62103 <br /> �� Ci of Oron � � C '� <br /> ,. �� � � � � .� <br /> �, Building Permit Application � �� <br /> w <br /> . ; for a Swimming Pool <br /> � Mailing Address: :'.�/�! <br /> 'Q`�� PO Box 66 �Permit numbsr: � G�/�D$`�jr.` <br /> Q Crystal Bay,MN 55323-0066 Date.•received:: '� � � ����''l�!��! � <br /> a �a. Sh�eetAddress: ReEeiv.ed b : . • � ... . <br /> Y � . . • <br /> � ��' 2750 Kelley Parkway .Plan�reVieVu•fee:,•��, ..g . . . . <br /> ��o�' Orono, MN 55366 . 9� ��� �� <br /> . T.�D b <br /> Ma�n: 952-249-460U Fax: 952-Z49-4816 www.ci.oronn.mn.us °�I Fee; „ � � � . <br /> This application form must be completed in full and all required information must be submitted, <br /> Incomplete applicatlons will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: .c� �_ C�u . . <br /> _ � .Q S s �x `�o���C�'d !`10 . � �1/^ ,.. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# lLArL��,T_ LS /�C,' <br /> Expiration Date: <br /> Phone: – — F�: <br /> Address: ' Ci : ' ZIP: <br /> Contact Person: Contact's phone number ���e�.��� <br /> Email o o A licant is: ontracto Homeovmer �c��one� � <br /> PR�PERTY OWNER INFORMATION: <br /> Name: � �.�. _ <br /> Phone(day)� . � <br /> Mailing Address: p u SE ZIP: s` <br /> Email and/or Fax <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: Ci : ZIP: <br /> Email Fax: <br /> PROJECT INFORMATION: <br /> 1.Pao�Dimensions: 4.p►ccessory tn_ 5.Pool Type: 6.Sew�ge Disposal8� <br /> � � � Water Supply <br /> — � � �"a—�t �Single Family ❑Abwc ground <br /> 2•Heated' � ❑Multiple Family/Condo �In-ground ❑ Public Sewer <br /> �y�'� �n° ❑Public �}Private Sewer <br /> 3. Excavated materials wlll be: ❑Commeraal ��her(Spedfy) <br /> � ❑ Public Water <br /> �nemoved from s"�te ❑Indus#rial ' 6.Retaining Walls? �Private Well <br /> Q used on site ❑Other:(specify) . <br /> ❑yes �no <br /> ❑O#her,(specify) <br /> Height__ <br /> Total Cubic Yards <br /> � Estimated Construction Valuation $ 3� Q <br /> Last Updated: 10/28/2010 • <br /> -7- <br />