Laserfiche WebLink
a. <br /> City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> �.--- Mailing Address: c�( :� '��'D�--�� <br /> ��g,�,�:\ PO Box 66 Permit number: <br /> �� � ��� Crystal Bay, MN 55323-0066 Date received: ���?���iZ <br /> J <br /> �`��� �� StreetAddress: Received by: �� <br /> � � ���:> ,�, <br /> '$',�, ��+� ��ti' 2750 Kelley Parkway ��� _��a•�,�� Plan review fee: >�� - Z�'' 7� ; C� <br /> t , Esxo� 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 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: ����- ��f,��,,,, �< < <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: � �,y,�� i�ac�c -� 5r•�� <br /> State License# �O�ea�S �S�a Expiration Date: jJ-/�/ <br /> Phone: ��v3-•��7- �� Fax: '713� S�/� 4�� <br /> Address: City: ��r�i ZIP: / <br /> Contact Person: � � ,�„�,r Contact's phone number 6,3- �� - 4m� <br /> Email ��q,evvFir ( l,�,c�nti�na� — S,oq �.N Applicant is: ontractor Homeowner (CircleOne) <br /> PROPERTY OWNER FORMATI /� / <br /> Name: �/d,rt�N�'3' i.aD C � / l'�Gl�(C �{ �,c�' , <br /> Phone (day): `/'3sa. �a,�. /�-�'9- �53U <br /> Mailing Address: ��n s'3 ,� „� ,� ZIP: �7 <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: 4. Accessory to: 5. Pool Type: 6. Sewage Disposal & <br /> Water Supply <br /> � X �fy feet ingle Family ❑Above ground <br /> ❑ Public Sewer <br /> 2. Heated? Multiple Family/Condo �In-ground <br /> �yes ❑ no � Public ❑ Private Sewer <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> ❑ Industrial 6. Retaining Walls? '�Private Well <br /> ❑ removed from site <br /> (�sed on site ❑ Other: (specify) <br /> ❑ yes �no <br /> ❑ Other:(specify) <br /> Height <br /> ,S� Total Cubic Yards <br /> Estimated Construction Valuation $ �6 �� <br /> Last Updated: 10/28l2010 <br /> -7- <br />