Laserfiche WebLink
, <br /> City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> Mailing Address: Permit number: �lo�- � g 7 <br /> �,�,�.\ PO Box 66 <br /> � �\ ��,,\ Crystal Bay, MN 55323-0066 ate received: �"�j '� <br /> �" '"� I� Rec 'ved b <br /> ,� `�'�,�: �` �, I Street Address: Y� <br /> �' ��� '����>��� ti�'� 2750 Kelle Parkwa <br /> c���,��=�,�� Y Y Plan re ' w fee: '� � , � <br /> k E S H�4' Orono, MN 55356 d r 0� a,v-� g 7-� <br /> - Total Fee� <br /> Main: 952-249-4600 Fax: 952-249-4616 w�,^r,^� i o no.mn.u� <br /> This application form must be completed i full and I equired inform on st be submitted. <br /> Incomplete application will be r t rned. (Ple�se print --� <br /> GENERAL INFORMATION: � j� <br /> Job Site Ad ess: Z6 �,�� Df. <br /> CONTRA OR I APPL AN INFO� A�TION: <br /> Name: ��-G� � ��d <br /> State License# piration Date: <br /> Phone: /, (� ax: <br /> Address: � ' P �� (.� ' �� Cit : � � /a.c.�.- ZIP: �- � <br /> � ,_ <br /> Contact Pers n: - <br /> �cG� / ContacY phone number �_..- <br /> Email A I� ant is: Contractor Homeowner • ���oie one� <br /> � <br /> '�_. <br /> __... <br /> PROPERTY OWN INFORMA ION: <br /> Name: �,h q ll� �_,.�. <br /> Phone (day): <br /> Mailing Address: �ZO � ��,h r. ZIP: �3�' <br /> Email and/or Fax <br /> ENGINEER INFORMATION: <br /> Name: ✓��C� � %N C. <br /> Phone: � 5"3+�- � - � _ <br /> Address: S '3 � � I' Cit : L.� ZIP: 7 S" �/ ( <br /> Email Fax: ���� - G�L��} - j� y 7 <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal 8 <br /> �� Water Supply <br /> X ��feet (�'Single Family ❑Above ground <br /> ❑ Public Sewer <br /> 2. Heated? ❑ Multiple Family/Condo J$(In-ground <br /> �(yes ❑ no � Public ,�Private Sewer <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> ❑ Industrial <br /> ❑ removed from site 6. Retaining Walls? �Private Well <br /> �used on site ❑ Other: (specify) <br /> ❑ yes � no <br /> ❑ Other: (specify) <br /> Height <br /> Total Cubic Yards <br /> 1 7 �'e`., <br /> Estimated Construction Valuation ,J _.� � <br /> Last Updated: 10/28/2010 <br /> - 7 - <br />