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City of Orono <br /> Building Permit Application <br /> � for a Swimming Pool <br /> � �,0,�. Ma��iPO Bo�r66. Permit number: Z�( �"—��-'�{�°� <br /> Crystai Bay, MN 55323-0066 Date received: � Z`� � � Z <br /> ,a �� O � i�t f I� <br /> � <br /> ���� '°- �, Street Address: Received by: -- <br /> '�' ,� i „` � 2750 Kelle Parkw "�.'� � . - � � <br /> �' o y �Z�IZ=C04�( � Plan review fee: ��. y� _ C�c • <br /> ��kESH�g� Orono, MN 55356 _ ._ _. _�___ ___�--_____.___ <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be compieted in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: L.�'� S� �- �� �,/3���� L��, � <br /> CONTRACTOR I APPLICANT I FOR�!ATI N: <br /> Name: �R S �Q c�/s ��- <br /> State License# �t..� Expiration Date: <br /> Phone: - (� - ��3 Fax: �; - � � <br /> Address: �/o� Gro'�dd� �"(� `ULL ity: ZIP: S„5�� �_ <br /> Contact Person: �� y ContacYs phone r <br /> ),.-,� <br /> Email �v�,� Applicant is� Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: / <br /> Name: ��4 c..l( � �-�isva.� �U� n,,� � tl S� C�Lc. - �CZ - (�`� —�� �� <br /> Phone (day): ���� <br /> Mailing Address: �f 3 S:S � [,i�► Z�P: :S� <br /> Email and/or Fax ��� � <br /> ENGINEER INFORMATION: <br /> Name: ���-c-� �,L��Gs �J�z��s D � �-7` ���� -��� <br /> Phone: <br /> Address: � ���� c� ,�`� Cit : < c,v ZIP: Oc� <br /> Email ' ax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal & <br /> Water Supply <br /> �X��feet ❑Above ground <br /> (�Single Family <br /> ❑ Public Sewer <br /> 2. Heated? ❑ Multiple Family/Condo �Q In-ground <br /> (�yes ❑ no �,Private Sewer <br /> ❑ Public <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> �..removed from site ❑ Industrial 6. Retaining Walls? �Private Well <br /> ❑ used on site ❑ Other: (specify) <br /> '�J yes �no <br /> ❑ Other: (specify) <br /> Height��oG� <br /> �'�� Total Cubic Yards fj��� � - l 5 i�� <br /> Estimated Construction Valuation $ ��� ��� <br /> Last Updated: 10/28/2010 <br /> - 7 - <br />