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City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> Mailing Address: Permit number. c,7 /1- )402-.01?-- <br /> 0 4 Cr Box 66 <br /> ® _�'®\ Crystal Bay,MN 55323-0066 Date received: /4 -2/-1 ./ <br /> Y' <br /> y;--tti rStreet Address: '- :' ed b . L� / 7;i�ti� G2750 Kelley Parkway Plan review fee: ' / l-- Ao$*v Orono,MN 55356 <br /> ota ee: -` 5--b . 3-9 <br /> Main: 952-249-4600 Fax 952-249-4616 www.cl.orono.mn.us '-7 , (:),-,-;----------. / <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: 10 60 0IJiM,1,,LA ?D, ©leoNa • Mi✓ , S 3.c <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: OL3'MPiG Pc.L- S <br /> State License# Z o 6 39 9 Expiration Date: <br /> Phone: .4('95-Z - Z21---- Z 2-a o Fax: 1,5-z- tf h - 7$6 7 <br /> Address: (3 S ATre.•cab Si. S- City: aQo.- ZIP: -s•3 7. 4 <br /> Contact Person: Contact's phone number <br /> Email 6k-a l t G1 c OI y pool S; (,@1/I Applicant is: Contractor Homeowner (Circle One) <br /> 616 (t i <br /> PROPERTY OWNER INFORMATION: <br /> (Jame: DIE LA.I.1 1.4.-C_. <br /> Phone(day): 763.3( 0. $139 <br /> Mailing Address: CA FT kLl ly *ASS&.., Si A rrcnn Blvd; 414961, $iaoft'J-rAZIP: 5A-1437 <br /> Email and/or Fax die.Lars i(c_a mi <br /> ENGINEER INFORMATION: `.Jga <br /> Name: /1/%c!/./1kg.wrj.' <br /> Phone: 75 3 - Z, :, - OD 7) <br /> Address: 141 to Z I s2 Air City:R„) 14-ac ZIP: 5S3o9 <br /> Email n,c146 ✓e. nill',.e,,,,_-► :..c. «-. Fax: - <br /> PROJECT INFORMATION: <br /> 1.Pool Dimensions: 4.Accessory to: 5.Pool Type: 6.Sewage Disposal& <br /> SpA Water Supply <br /> 12- X I Z feet L�1 Single Family 0 Above ground <br /> ❑Public Sewer <br /> 2.Heated? ❑Multiple Family/Condo In-ground <br /> yes <br /> 0 no ❑Public ❑Private Sewer <br /> 0 Other(specify) <br /> 3. Excavated materials will be: 0 Commercial 0 Public Water <br /> El"moved from site ❑ Industrial 6.Retaining Walls? 0 Private Wet <br /> ElOther:(specify) <br /> Iff'used on site <br /> ❑yes ❑no <br /> ❑Other:(specify) <br /> Height <br /> Z I Total Cubic Yards <br /> Estimated Construction Valuation $ :75,5 2.6. 0 p <br /> Last Updated: 10/28/2010 <br /> -7- <br />