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�f�1� /�1 i� � (� lZ � �'�,�Lf-� <br /> � <br /> �/ <br /> City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> .--_ - Mailing Address: Q�O_�D7s <br /> � � PO Box 66 Permit number: <br /> /' _ <br /> ��%� ��� Crystal Bay, MN 55323-0066 Date received: U �� Jd <br /> �' x �� <br /> �� `�r Street Address: Received by: <br /> 1�,'� 1� �� ,.. >,;; <br /> � <br /> 's',F, }� ��. �� Gti''' 2750 Kelley Parkway Plan review fee: <br /> \y,?�ESHo��� Oronq MN 55356 <br /> -_= Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orona 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) �—L�� C��d` I„� <br /> �� f� <br /> GENERAL INFORMATION: �De✓rn��' �13V VI�MI <br /> Job Site Address: 2400 Fox Street r�( �lN�u �(��> <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Desiqner Pools <br /> State License# Expiration Date: <br /> Phone: (952)447-6084 Fax: (952)447-6082 <br /> Address: PO Box 504 City: Prior Lake ZIP:55372 <br /> Contact Person: Jim Vossen ContacYs phone number <br /> Email Desi ner ools inte ra.net A licant is Contractor Homeowner �c�r�ie o�e� <br /> PROPERTY OWNER INFORMATION: ����`' ���" ' I� <br /> Name: Julie Lindbloom �� � �7i �� " �� <br /> Phone (day): (952)451-2002 <br /> Mailing Address: 2690 RAINEY ROAD ORONO ZIP:55391 <br /> Email and/or Fax <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 3.Accessory to: 4. Pool Type: 5.Sewaga Disposal& <br /> ❑Above ground Water Supply <br /> � Single Family 0 In-ground <br /> ❑ Public Sewer <br /> 20 X 44 feet ❑ Multiple Family/Condo <br /> �� 'f� '��u��T �� ❑ Public ❑Other(specify) �Private Sewer <br /> 2.Heated? <br /> ❑Commercial Excavated materials will be: ❑ Public Water <br /> �yes ❑ Industrial <br /> ❑ removed from site �Private Well <br /> ❑ no ❑Other: (specify) � used on site <br /> �Other: (specify) <br /> Asneeded <br /> Estimated Construction Valuation $ 145,000.00 <br /> Last Updated: 7/28/2010 <br /> -7- <br />