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City of Orono <br /> 414 � <br /> Building Permit Applications+ <br /> for a Swimming Pool <br /> OAj Mailing Address: Permit number: 0?4�y�OD <br /> l VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address: Received by: C%A <br /> y 2750 Kelley Parkway Plan review fee: Xo <br /> `qty ESHD Total Fee: <br /> ��� Orono, MN 55356 07o1V,�0p kV <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 information mus be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ) TIR <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: a �5 e0 s <br /> State License# A.1 ,t Expiration Date: <br /> Phone: ::2 6 3 " & 2 —4'3 ti 3 Fax: -7 63 r_ <br /> Address: I t 05�1' L ro-fyO Of N U/ r'+ <br /> Contact Person: <f'g�c.� <br /> Email: ,Ntj <br /> PROPERTY OWNER INFORMATION: ' /� �(,�C�— <br /> Name: 0'l -t ,S • 4' QG!'Ihl <br /> Phone (day): (,at 2 r 2. 3 'l ^ Y � <br /> Mailing Address: 7:, _��14 <br /> Email and/or Fax: &J— <br /> ENGINEER INFORMATION: <br /> Name: of <br /> Phone: '�- (� <br /> SlawAddress: r V'V 1 <br /> It <br /> Email: r( Jr WVV tJ1/V <br /> V� � <br /> PROJECT INFORMATION: �U�V <br /> 1. Pool Dimensions: 4.Accessory to: <br /> i <br /> i X f feet <br /> Single Family <br /> 2. Heated? El Multiple Family/Co <br /> yes ❑ no ❑ Public <br /> 3. Excavated materials will be: ❑ Commercial <br /> removed from site ❑ Industrial <br /> &used on site ❑ Other: (specify) <br /> ❑ Other: (specify) <br /> l3 Total Cubic Yards <br /> Estimated Construction Value <br /> Packet Last Updated: 03129/13 <br /> Page 19, <br />