2011-01182 (in ground pool) - Laserfiche WebLink

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,�... , ,0��1 �� , a�' ,, � �� c � � City of Orono �`' �a73oD � Building Permit Application for a Swimming Pool Mailing Address: Permit number: 076//—D��L O�,�O PO Box 66 Crystal Bay, MN 55323-0066 Date received: ��"�— �f `�\. � ,� �`��r s�;,�, �� Street Address: Received by: �'.�, ,��,�� Gti 2750 Kelley Parkway Plan review fee: /7Z.�J� t�kESHOg'� Orono, MN 55356 �n��_��►� --- Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: �j�U �A � � , CONTRACTOR LI ANT INFORMATION: Name: � �,�K � ��:I'� State License# � Expiration Date: Phone: (b�i 1 �', 39�1� Fax: (L�,�I�31-4�3`�Z Address: � S : $'�U ' Cit : ZIP: Contact Person: I-�C�,. �,��,�,��..` Contact's phone number ` .: Email �G��,�1,t,�L @CL,•,�yzSr� t�� Applicant is: ontractor � omeowner (CircleOne) PROPERTY OWNE INFORMATION: Name: .E Phone (day): � � � Mailing Address: 35 U � QG - ZIP: S' Email and/or Fax ENGINEER INFORMATION: Name: Phone: Address: City: ZIP: Email Fax: PROJECT INFORMATION: 1. Pool Dimensions: 4. Accessory to: 5. Pool Type: 6. Sewage Disposal & � X �� feet Water Supply Single Family ❑ Above ground (�Public Sewer 2. Heated? Multiple Family/Condo In-ground ❑ yes �no ❑ Private Sewer ❑ Public ❑ Other(specify) 3. Excavated materials will be: ❑ Commercial ❑ Public Water ❑ Industrial ❑ removed from site 6. Retaining Walls? ❑ Private Well �used on site ❑ Other: (specify) ❑ yes �no ❑ Other: (specify) Height Total Cubic Yards c.� Estimated Construction Valuation $ ��,(''� Last Updated: 10/28/2010 - 7 -