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, � � �`J`- �r✓ City of Orono � -� �� i , , �,ti Building Permit Application , � for a Swimming Pool - Mailing Address: �,�,� PO Box 66 Permit number: ��'<<� �• '<�� Q � � Crystal Bay, MN 55323-0066 Date received: �� "�/� ' /�' ��,. ,`�� Re ' d b : ___ � � ,�,�„A� �, Street Address: – - — _ I �,n ' �� 2750 Kelle Parkwa , l f -� 5/ •,�. � �� Y Y Plan review fee: L�kE3H04' Orono, MN 55356 ----- . �______�_i � �C�3 .___.- ---- otal ee: ------ Main: 952-249-4600 Fax: 952-249-4616 w�rJsv ci orono rnn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: �3�U �� 1��f� �a�/ CONTRACTOR/APPLICANT INFO�ATION: Name: GVv.�Z��i� 1"�cAS L �L State License# Expiration Date: Phone: C�'�z c�+�'��7�U� Fax: Address: �035'� �;./od Q /��/ %�1��/- City��,�/� ,• � ZIP' �'S"d jt.� Contact Person: , I,�,,�(-, t.��t_ ContacYs phone number(��1- ��y ��,�fQ Email Applicant is: Contractor Homeowner �c��ie o�e> PROPERTY OWNER INFORMATION: Name: �,7� l��s Phone (daY)� .�3Yo G'o�e,�i1�� f/ � Mailing Address: ZIP: Email and/or Fax ENGINEER INFORMATION: Name: Phone: Address: City: ZIP: Email Fax: PROJECT INFORMATION: 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal 8� ZO X �p feet Water Supply [�Single Family ❑Above ground 2. Heated? ❑ Multiple Family/Condo �n-ground � Public Sewer �s ❑ no ❑ Private Sewer ❑ Public ❑ Other(specify) 3. Excavated materials will be: ❑ Commercial ❑ Public Water �removed from site ❑ Industrial 6. Retainin Walls? g ❑ Private Well �used on site ❑ Other: (specify) ❑ yes ❑ no ❑ Other: (specify) Height Total Cubic Yards Estimated Construction Valuation $ �`,��Oc�� Last Updated: 10/28/2010 - 7 -