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f <br /> ! � � <br /> ' � Cit of Orono /6� �' �� <br /> y � <br /> Building Permit Application � , <br /> . �'. �� i� <br /> for a Swimming Pool � <br /> Mailing Address: Permit number: �O�I�� ` <br /> O��,�.0 PO Box 66 • <br /> Crystal Bay, MN 55323-0066 -Date received: �p -'�'��' <br /> �, Street Address: Received by: � <br /> �,�,r ��ti�' 2750 Kelley Parkway Plan review fee: .�' ����. 7J9 C�� <br /> �kE9H�4' Orono, MN 55356 <br /> � ao��-oo �� <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: ( (D O /1,(( C,L 5�'t�J (L�Arp <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: p�-'{M PK- pou c,s <br /> State License# Zc�y SfS Z 31 Expiration Date: �{-[• Zc�t 'L <br /> Phone: �S�2� 22Y- 2 t�o Fax: g$Z-YYS'- 7�6 7 <br /> Address: t SS /t't W�1� STRr.� 5 a City: S ttl��cG�' ZIP: S53 Z 9 <br /> Contact Person: �C�viN �3�'t RR�ETT ContacYs phone number Q S 2•Z2Y- Z ZGb <br /> Email �G sR R R ts-'TT �t.YP�xLS• Gc.� Applicant is: _ontractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: i�vD � ��ttZ��eA� $t�tltWEz.�. <br /> Phone(day): <br /> Mailing Address: ��Gu /N, �LC.S t� l��t� , OR�c� ZIP: s5 3q( <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 /> 5 y I X Z Z � feet �Single Family ❑Above ground <br /> ❑ Public Sewer <br /> 2. Heated? ❑ Multiple Family/Condo 8 In-ground <br /> �yes ❑ no � Public ❑ Private Sewer <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> � removed from site ❑ Industrial 6. Retainin Walls? <br /> g ❑ Private Well <br /> ❑ used on site ❑Other:(specify) <br /> ❑ yes �no <br /> ❑ Other:(specify) <br /> Height <br /> Total Cubic Yards <br /> Estimated Construction Valuation $ � �� U vd <br /> Last Updated: 10J28/2010 <br /> -7- <br />