2015-00565 - advance plan review fee

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..-�----, -�� � . . City of Orono Building Permit Appiication for �a Swimming Pool ll�ailing Add�ss: �-�( c-._ S �O�O PO Box 66 Fermit number. , _ Crystal Bay, MN 55323-0�6 Date received: —j�j � StreetAddress: � Received by: � ,,� y `�jZ y�, � 2750 Kelley Pa y 2�J �5"�%'�(�i Pian review fee: . 2� �� � � Orono, MN 55356 y q'�f S H O�'`4• ---- ---=__...._ Totai Fee: -- ___ Main: 952-249-46Q0 Fax: 952-249�616 www.ci.orono.mn.us 7his application form must be completed in full and a11 required information must kre submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: � �-1 �'��L� �+ � L CONTRACTOR/AP ICANTINFORMATI p Name: ��.2�F��na��oo� �V�PA State License# ��,r�5��,L-�� Expiration Date: � Phone: (�,5 f) �`15- 3 9�1 O Fax: �� 1-$ 7�- Address: .p Ci : -} ZIP: S Contact Person: 1 ContacYs phone number 5- 9 c� Email: � � �"A licant is: n r Homeowner �a►cie or,e PROPERTY OWNER INFORMATION: Name: ^h Phone(day): Z, � -1 I Mailing Address 1 �p Z�p: � �� Email and/or Fax: ENGtNEER INFORMATION: Name: Phone: Address: City: Z1P• Email: Fax: ' PROJECT lNFORMATION: 1.Pool Dimensions: 4.Accessory to: 5.Pool type: 7.Retaining Walls? �� X �1 O feet (�Single Family ❑Above r ❑yes [�no Height 2.lieated? ❑Multiple Family/Corido �]o In-groun� *A building pertnit is required �yes ❑no []public —'� for any wall o�er 4 feet in fher(specify) height measured from the 3. Excavated materials will be: ❑Commercial bottom of the footing to the top ❑Industrial of the wall, even if it replaces ❑removed from site 6.Sewage Disposal& an existing wall. �used on site ❑�ther:(specify) Water Supply Tiered walls are considered ❑Other:(specify) ❑Public Sewer one wall unless they are separated by twice the height ' �Private Sewer of the higher wall. �_Total Cubic Yards ❑Public Water �ry�� Private Wetl Estimated Construction Value $ Packet Las[Updated.� 0329/13 Page 19 of 21 "