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101?�126�12 ' 04: 17 9529855323 QUALITY POOLS PAGE 02103 <br /> . <br /> ' Cit of Orono � � � '� <br /> Y � <br /> Building Permit Application �� �d� <br /> for a Swimming Pool <br /> Mailin�Add�ss: a0��_ <br /> 'Q��� PO Box 66 permit number: �ld,�`j� <br /> Q Q Crystal Bay, MN 55323-0066 Date.received:. ' ' ����'j��� <br /> a �. StreetAddress: Recefued by: <br /> �i ��`' 2750 Kelley Parkway Plan'reVieVu fiee:• � ..g <br /> ��sxoa� Orono, MN 55366 ' � <br /> ia-���o �, , <br /> Main: 952-249�600 Fax: 952-249-4816 www.ci.orono.mn.us Total Fee: <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications wi(I be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: c� � �u € �o Q � � <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��L����j �. <br /> State License� Expiration Date: <br /> Phone: — — Fax: <br /> Address; ' Ci : ZIP� <br /> Contact Person: . Contact's phone number <br /> Email a o g A licant is: ontractor Homeowner (Circle One) <br /> PROPERTY owNER INFORMAT�oN: <br /> Name: C(� <br /> Phone(day)� <br /> Mailing Address: Q � s g ZIP: s' <br /> Email and/or Fax <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: Cit : <br /> Email ZIP_ <br /> Fax: <br /> PROJECT INFORMATION: <br /> 1. Pao�Dimension9: a.Accessory tn� 5. Pool Type: 6.Sewage Disposal& <br /> — � (,� _ �Q. Weter Supp�Y <br /> �X feet �g;ngle�amily ❑Above ground <br /> 2. Heated? ❑ Public Sewer <br /> ❑Multiple Family/Condo �In-ground <br /> ❑Y�� ❑ no <br /> ❑ Public ❑ Other(specify) �Private Sewer <br /> 3. Excavated materiais wlll be: ❑ Commercial ❑ Public Water <br /> �removed from site ❑ Indus#rial 6.Retaining Walls? �Private Well <br /> ❑ used on site ❑Other: (specify) <br /> ❑yes �no <br /> ❑Other,(specify) <br /> Height__ <br /> Total Cubic Yards <br /> ' Estimated Construction Valuation $ 3O Q <br /> last Updated: 10/28/2010 • <br /> -�- <br />