Laserfiche WebLink
� . . City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> ,O; Mailing Address: � Q J� -����� <br /> \ PO Box 66 Permit number: , � <br /> �� � �. <br /> / Q . Q�� Crystal Bay, MN 55323-0066 Date received: �- �- / / <br /> � <br /> I �''` �' � Received b ��� <br /> ,� '� ��.�.2 a, Street Address: <br /> Y� <br /> �'�,c, �', '" ��' 2750 Kelley Parkway :�?C!!-•�C(!�� Plan review fee: `� �� 7�' . `G'� <br /> � � ���v Orono, MN 55356 <br /> �kESHo4 <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: ����) `��,.�� ��t� � <br /> c,r?/� <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 1�i�if�� ..���=J� ..._ -5-i,�i7 <br /> State License# �c;.�,��s� Expiration Date: y�� -,/j <br /> Phone: '7�,� ��'� -ioi�:� Fax: '?�3 __�;iJ -�lc�y <br /> Address: -..,i, ,�✓ / t' Cit ����>,�>c�f�✓ ZIP: -�-i <br /> Contact Person: /- _��.,.,- ContacYs phone number <br /> Email Applicant is: Contractor Homeowner (Circ�e One) <br /> PROPERTY OWNER�D�FsORMATION: <br /> Name: __�{1�cft � J�fN�it� �c..�-c�oLv <br /> Phone (day): 9' --��y - 4v <br /> Mailing Address: �3�� �.�,am,f�cC '�� ZIP: <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 y� feet Water Supply <br /> �"5ingle Family ❑ Above ground <br /> ❑ Public Sewer <br /> 2. Heated? ❑ Multiple Family/Condo (�In-ground <br /> �yes ❑ no �;Private Sewer <br /> ❑ Public <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> [�removed from site ❑ Industrial 6. Retaining Walls? (�Private Well <br /> � ❑ Other. (specify) � <br /> ❑ used on site <br /> ❑ yes �ho <br /> ❑ Other: (specify) <br /> Height <br /> Total Cubic Yards <br /> Estimated Construction Valuation $ 7�, �� ' <br /> Last Updated: 10/28/2010 <br /> - 7- <br />