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��/ �� City of Orono � Building Permit Application 5q�, �.S d-� for a Swimming Pool Mailing Address: •' C�� --(h//��_ ��,��. PO Box 66 Permit number: / \\� Crystal Bay, MN 55323-0066 Date received: / / � ` �� - - �4 � � I� Received by: �� �� `�r�R� �:� �,,i StreetAddress: ��. � � �, . �ti 2750 Kelley Parkway -��1 C�1 f-�c"'l�J ) Plan review fee: _� 7�- �� Z.9kEsxOg� Orono, MN 55356 —— Total Fee: ao //-bllz'1 Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: Job Site Address: "1�_�� i�� c / f�Ge'1/� CONTRACTOR I APPLICANT INFORMATION: Name: .(��.�if�� %�C�'� -� ,�5.�i7 State License# ��,��lS,� Expiration Date: �;/-i� -j� Phone: '7l-� .��"a-�i0�� Fax: '�� S�f._> � �iG�� Address: c./ ,Lo / �' Cit : �� a�>c��% ZIP: G��Yv�i Contact Person: / .c��,� ContacYs phone number Email Applicant is: Contractor Homeowner (Circle One) PROPERTY OWNER�sORMATION: Name: �✓/�U�r1c� � .D��'ii4 �c��o�v Phone (day): 9 --�jy - 4� Mailing Address: �3�G �.��ifr�c � �� 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� Water Supply r-�U X ��J feet "�ingle Family ❑ Above ground � ❑ Public Sewer 2. Heated? ❑ Multiple Family/Condo �'In-ground �yes ❑ no � Public �.�rivate Sewer ❑ Other(specify) 3. Excavated materials will be: ❑ Commercial ❑ Public Water [�removed from site ❑ Industrial 6. Retaining Walls? �Private Well �❑ used on site ❑ Other: (specify) ❑ yes �ho ❑ Other: (specify) Height Total Cubic Yards Estimated Construction Valuation $ 7�f �� ^ Last Updated: 10/28/2010 -7-