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f <br /> City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> .0/�, Mailing Address: Permit number: C:741/1-0/tea -_ <br /> :°,hr Cr Box 66 <br /> I y Crystal Bay,MN 55323-0066 Date received: �Q -2/-/c./ <br /> I il:4;`,,,, <br /> / <br /> 1/44'1%." <br /> '„ StreetAddress: =• ed by: <br /> 2750 Kelley ParkwayPlan review fee: /'�-�/p�g0Orono,MN 55356 i <br /> o r: ee: <br /> I' .5-b% 39 <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 must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: /d 60 �QJO//,ty t,../A ?D, <br /> ©R o/v a . NM/ .y3s- " <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ©LT/APic. Poco S <br /> State License# Zr,6 3 9 m} Expiration Date: <br /> Phone: '9cZ - 7-21-- Z z a p Fax: 15-2-`1,95'- 7$6 7 <br /> Address: /3 c A-1,,c.._19 S;, S. City: p ZIP: £ 3 7 4 <br /> Contact Person: Contact's phone number <br /> 04GE�1 I- 6k-4 1 I VI c of y/20©l sc (,14/1 Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: DE LA Ki_ i.-1,C— <br /> Phone <br /> LCPhone(day): 763.360, 2139 <br /> Mailing Address: o ET K.ei Iv ASSCC.i 5001 American 131val„ *I 661.1/ 81Donr' ZIP: 5',5 37 <br /> Email and/or Fax di ( gmct <br /> ! - s I JJ <br /> ENGINEER INFORMATION: J <br /> Name: AI;c v.Aki... c,. <br /> Phone: 76 3 - Z, ' - 71 <br /> Address: o ss : — Cit • . ZIP: SS <br /> Email cl ck& re. evil ir,ec,., ,J ,„,to.. Fax: _ <br /> PROJECT INFORMATION: <br /> 1.5l Dimensions: 4.Accessory to: 5.Pool Type: 6.Sewage Disposal& <br /> !2 X I Z. feetWater Supply <br /> IJ Single Family 0Above ground <br /> 0 Public Sewer <br /> 2.Heated? ❑Multiple Family/Condo In-ground <br /> yes ❑n° ❑Public ❑Private Sewer <br /> 0 Other(specify) <br /> 3. Excavated materials will be: ❑Commercial <br /> 0 Public Water <br /> ❑re oved from site ❑Industrial 6. Retaining Walls? 0 Private Well <br /> used on site 0 Other:(specify) <br /> ❑Yes ❑no <br /> EDOther:(specify) <br /> Height <br /> Z I Total Cubic Yards <br /> Estimated Construction Valuation $ 75,S2-6. o o <br /> Last Updated: 10/28/2010 <br /> -7- <br />