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t1 .31 ,-'1 --RICEIVED <br /> City of Orono JUL 1 1 2014 <br /> Building Permit Applica <br /> CITY OF ORONO <br /> for a Swimming Pool 2 <br /> �T Mailing Address: Permit number: do/t-ero73,' <br /> �-.�VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 'l -I <br /> Street Address: Received by: O vi 1 -I ' <br /> C' 2750 KelleyParkway <br /> V. k <br /> 6� L~ Y Plan review fee: <br /> tq 4� Orono, MN 55356 ap Iv-00735 <br /> kESH� <br /> Total Fee: l— Y ..V edl <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us V..�� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ar1r00 [drab 04, bqk O(Ono)l'1N 536 <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �'ji 2 omn Pools <br /> State License# (7) ,a05Da.,3 Expiration Date: 3/31 /0201b <br /> Phone: ' d - q33 -2 55 Fax: 95a- ' 3-24.51 <br /> Address: �;(a0`Irl 1Va.01e,310 o CitContact's phoney. N.�ktn5�5. _ ,yZIP 'S�q-3 <br /> Contact Person: y`f • -r <br /> Email: WWW. ic 54anpoo l5l no_ CO 'n Applicant is: ���� • omeowner (circle One) <br /> Bbl ikii@ CLOt0YY1 0051 r e,,Com <br /> PROPERTY OWNER INFORMATION: <br /> Name: J61(1 t K(iokheii'►e, 61Q.hnon <br /> Phone (day): 93);- qq4- aaph <br /> Mailing Address: .2160 tAjte1rrpJ241r.etr(I i ©wo )MN ZIP: 55554 <br /> Email and/or Fax: Kabisivoul@ Qma.fl , G0M <br /> ENGINEER INFORMATION: J <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> ((�� i I <br /> I() x 3 feet Above ground ❑yes 'Ig no Height <br /> Single Family <br /> 2. Heated? ❑ Multiple Family/Condo 'In-ground *A building permit is required <br /> ayes ❑ no ❑ Public for any wall over 4 feet in <br /> ❑ Other(specify) height measured from the <br /> 3. Excavated materials will be: ❑ Commercial bottom of the footing to the top <br /> ❑ Industrial of the wall, even if it replaces <br /> 0 removed from site 6.Sewage Disposal & an existing wall. <br /> used on site <br /> 0 Other: (specify) Water Supply Tiered walls are considered <br /> 0 Other: (specify) ❑ Public Sewer one wall unless they are <br /> separated by twice the height <br /> Private Sewer of the higher wall. <br /> Total Cubic Yards <br /> ❑ Public Water <br /> 'Private Well <br /> Estimated Construction Value $ (;,0)000 <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />