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<br /> . � City of Orono � oo���
<br /> Building Permit Applicatio �
<br /> for a Swimming Pool c�
<br /> Mailing Address: � �a„
<br /> �,L,�,j��\\ PO Box 66 Permit number:
<br /> � o\� Crystal Bay, MN 55323-0066 Date received: q-���Z
<br /> '�� \
<br /> �:: ..T, /��c�
<br /> a ��''4�.-;�" ,, Street Address: Received by: 4�c�
<br /> �'�, . �'����� � ti 2750 Kelley Parkway Plan review fee: ,��! �
<br /> t���r���G Orono, MN 55356 �3� l� Y`
<br /> Esx p�D1oZ—��7�
<br /> - Total Fee:
<br /> Main: 952-249-4600 Fax: 952-249-4616 w,:^r;v s�.oronc.mn.us ,�. � yp� _� �
<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: :�.3�,�; ���X �� ;�.� ���;�,1� � M►� .
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> Name: `���,,.�� �'- �� , �.1�...,��. '�-L�
<br /> State License# �C.,c�c�3��.i Expiration Date: •?, �3 � ao�
<br /> Phone: q��Z— y��3�- 5y �r� Fax:
<br /> Address: i 4j 3 p (v�;,,�,,�,�-��;,...Ic�` vc� • Cit : �,'t. •7y�-�u ZIP: " �3`1 S
<br /> Contact Person: Joe. (�(�.r.. �.r� �e.-✓' Contact's phone n er (�,i�—i-(I�( �-S1l 3
<br /> Email ,���:, S.�e;y„�,. �� p ` �;�,,�,,,,- ��,..�, Applicant is C ontractor Homeowner (Circle One)
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: t�w�,�y f�;�e;��
<br /> Phone (day):
<br /> Mailing Address: ����yo �x �re��- Q.�-�;,�� Mtv. ZIP: ���c,�
<br /> Email and/or Fax '
<br /> ENGINEER INFORMATION:
<br /> Name: C��oKlo e.r � I�SSoG;c,.,-E.�S ZKc--
<br /> Phone: 95� —y —c.ti t `4 l
<br /> Address: r.�y� �or-��;llow J7r City: �.a„�c� L-�.. c.�- ZIP• �� �(P
<br /> Email Fax:
<br /> PROJECT INFORMATION:
<br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal &
<br /> �. , �� � Water Supply
<br /> '�� �� X �v� feet '`�Single Family ❑ Above ground
<br /> ❑ Public Sewer
<br /> 2. Heated? ❑ Multiple Family/Condo �n-ground
<br /> �yes ❑ no �Rrivate Sewer
<br /> ❑ Public
<br /> ❑ Other(specify)
<br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water
<br /> ❑ Industrial
<br /> ❑ removed from site 6. Retaining Walts? �Private Well
<br /> �used on site ❑ Other: (specify)
<br /> ❑ yes "[�,n o
<br /> ❑ Other: (specify)
<br /> Height
<br /> Total Cubic Yards
<br /> Estimated Construction Valuation $ �� , Ud U �vv
<br /> Last Updated: 10/28/2010
<br /> - 7 -
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