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�-4� � � �O <br /> . � � Co S (- .� zs=-�o�l L <br /> City of Orono � <br /> Building Permit Application <br /> for a Swimming Pool ��'Q ���rimWa�lO'Y1S. �m <br /> �O� Mailing Address: Permit number: �l�U � <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —/D —/ <br /> Street Address: Received by: <br /> y � 2750 Kelley Parkway Plan review fee: <br /> `� L Orono, MN 55356 <br /> l�kFSH��� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 ��v�rrr�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: �� �� �� �� <br /> CONTRACTOR/APP ICANT INFOR TION: <br /> Name: /�/�f5�/E� /��� <br /> State License# Expiration Date: <br /> Phone: • 3 Fax: �S/��/ �?- ,�' / <br /> Address , c� _ icl�S ' Cit : �' ZIP:S 5 / <br /> Contact Person: — ContacYs pho <br /> Email: - ,t �,yl �� , �aw� A licant i Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: /yj��k ,J,�!_p/�S� <br /> Phone (day): '7� 3.- �a— "'� <br /> Mailing Address: �` -��"� o)( ST'. ZIP:�3q/ <br /> Email and/or Fax: ,J q-.�o�g 5 O�i M 2 Cd G/1�i4/� ` ��� <br /> ENGINEER INFORMATION: <br /> rName: <br /> `Phone: <br /> Address: City: ZIP: <br /> ' Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> v� � X�feet ❑ Above ground ❑ yes �no Height * <br /> �Single Family <br /> 2. Heated? ❑ Multiple Family/Condo [�jln-ground "A building permit is required <br /> �] yes ❑ no for any wall over 4 feet in <br /> . � ❑ Public <br /> ❑ Other(specify) height measured from the <br /> 3. Excavated materials will be: ❑ Commercial bottom of the footing to the top <br /> ,✓ �. of the wall, even if it replaces <br /> �removed from site :7 ❑ Industrial g p g <br /> C? 0 6. Sewa e Dis osal 8� an existin wall. <br /> [�used on site s� `/� ❑ Other: (specify) Water Supply Tiered walls are considered <br /> ❑ Other: (specify) ❑ Public Sewer one wall unless they are <br /> separated by twice the height <br /> [�Private Sewer of the higher wall. <br /> Total Cubic Yards <br /> ❑ Public Water <br /> Private Well <br /> Estimated Construction Value $ � ,��p <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />