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• <br /> • 3 -Lf--°1541v - <br /> City of Orono 520 -oq <br /> q <br /> Building Permit Application <br /> for a Swimming Pool <br /> ��l V Mailing Address: Permit number: 09013 - OC, (0 16 <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7-3 -13 <br /> 86 <br /> Street Address: Received by: S <br /> y� 2750 Kelley Parkway Plan review fee: (go ra-to bo et <br /> Orono, MN 55356 01 C _ <br /> 1KFSH° Total Fee: 4120l.34P <br /> Main: 952-249-4600 Fax: 952-249-4616 wnry ci orono mn us <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 INFORMATIO • ��/ c <br /> Job Site Address: -5 /,Ti'�CGG'C�`" /e4C-3 /d, <br /> Name: (i <br /> I AP i./ �9N7 F RAA*zw ej1+1`/��� <br /> State License# w r e Expir n Date:C/ 3 — ,3r-„. /' <br /> &/ <br /> Phone: S Fax: � ;3 Z ,-„1.,../. <br /> Address: ___ A,,, ;4-'g Cit : . � - I P j I eC <br /> Contact Person: . jfl ! Contact's phone n •-•AlcIEEVAIMAFAM <br /> Email: ---;/ ,� 4 .a I _,, ,_.,r A.•licant is: ontract• Homeowner (Circle one) <br /> PROPERTY OWNER INFORMAT N: <br /> Name: 1 _' /244 �i.�'�/ <br /> Phone (day): �j �/ <br /> Mailing Address: 9- r L �G (e/ �, ,/� '/� > ZIP:53:9 <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: ��f 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> X `, -/ feet El Above ground Oyes ❑ no Heighf� ' <br /> ` ” <br /> Single Family <br /> 2. Heated? ❑ Multiple Family/Condo ,gIn-ground *A building permit is required <br /> /14 yes ❑ 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 /> CI Industrial of the wall, even if it replaces <br /> SA removed from site 6. Sewage Disposal & an existing wall. <br /> Xused on site ❑ Other: (specify) Water Supply Tiered walls are considered <br /> 1:1Other: (specify) ❑ Public Sewer one wall unless they are <br /> separated by twice the height <br /> ,50 Private Sewer of the higher wall. <br /> Total Cubic Yards CI <br /> ❑ Public Water <br /> 017 yp '– <br /> Estimated Construction Value $ <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />