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, � <br /> City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> ��� Mailing Address: Permit number: `,�� � (~�� �`� <br /> /�/�g,a,j�.\ PO Box 66 _ <br /> Q ��,; Crystal Bay, MN 55323-0066 Date received: _> �c���i 2 <br /> ' � � ''� �%� <br /> ��a �'�t� :` �,;, Street Address: Receiv ed b y: <br /> ��'.�, .� _� ti� 2750 Kelley Parkway ._ ''�- <br /> l ����� �/ ,-�t,(�� -[;'C<z'�� Plan review fee: _� �3- �� , r'� <br /> �kE3H0� Orono, MN 55356 � �' ��-�� , aa� — i�i f���� �f, �� <br /> , -? <br /> '- — Total Fee: � f��"' � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �( `��� � �'f'" <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 I APPLICANT INFORMATION: <br /> Name: 1�,,ni,•.c. i�c,a� .i 5,•rar! <br /> State License# �p��5 �S�� Expiration Date: %�-/y <br /> Phone: �cFi3 • ,y��� Fax: '7G3� 5�/� 4ao� <br /> Address: Cit : �,�ri ZIP: / <br /> Contact Person: - � t„�r ContacYs phone number 6 � 3� - 4�� <br /> Email ��q,evv� ( l,a,�,��ndo� — S,c�O _ �fi� Applicant is: ontractor Homeowner (Circle One) <br /> PROPERTY OWNER FORMATI /� <br /> Nam e: ��/diz�3' ��irn C G - /��C��Il �1 � <br /> Phone (day): �'Z�. � _ 3 � <br /> Mailing Address: ��� �'3 � ,�,{, ZIP: ,�ir/�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 /> � X �fc� feet Water Supply <br /> ingle Family ❑Above ground <br /> 2. Heated? u Multiple Family/Condo In-ground � Public Sewer <br /> �.yes ❑ no � Public <br /> � ❑ 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 /> �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: 10/28/2010 <br /> - 7- <br />