Laserfiche WebLink
' <br /> i <br /> ,, RECEIVED <br /> City of Orono JUN 2 7 2017 <br /> Building Permit ApplicationRONo ��' <br /> CITY OF O <br /> for Swimming Pools and Hot Tubs <br /> A, • Mailing Address: Permit number: an/7-8-D7/5/ <br /> VS VI PO Box 66 <br /> -- ' Crystal Bay, MN 55323-0066 Date received: "-I 7/7 <br /> Street Address: <br /> Received by: ��� <br /> yF • 2750 Kelley Parkway 111 Plan review fee: 3 3�3, "-� <br /> L Orono, MN 55356 0,,, L,`1k�s►+o�� odd �7f-� r'73 <br /> Total Fee: �!G'��! <br /> Main: 952-24g-4600 Fax: 952-249-4616 www.ci.oro o.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: %-2-0 0& ('y s-Lk Z...7S. <br /> CONTRACTOR/APPLICANT INFORMATION:`� <br /> Name: C \-a)1 <br /> State License# (ikc/QS383 2/ Expiration Date: 3131 1 Ig <br /> Phone: `Jc2-Tao- (0$"99 Fax: <br /> Address: 23Y. 1)q,, Os Sk•ritt -- City: Lot,:,, Loe,�,VZIP: c-S- <br /> Contact Person: S '�cS Contact's phone numbe7Ic,3-1_g10--2g21 <br /> Email: t -e_s .,,. reXcc,PeS,cc,p-%_ Applicant is: on r ow Homeowner (circle One) <br /> PROPERTY OWNER I FORMATION: _ <br /> Name: k �,f'e-P,S <br /> Phone (day): -71p --2- -'L42q <br /> Mailing Address: 2p pl& ' \ %-..) {2� S. 0-1 Al ZIP: SS3"i <br /> Email and/or Fax: \- Q_„(,„ ex�, 124D-..e...0 <br /> 1,.�, <br /> ( rst) v� <br /> ENGINEER INFORMATION: 1 <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1c Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> Lkin X ZC feet i <br /> 2. Heated? fX1 yes 0 no tst.Single Family 0 Above ground 0 yes fg no Height * <br /> 3. Excavated materials will be: 0 Multiple Family/Condo RI In-ground *A building permit is required <br /> ig removed from site for any wall 4-feet or greater in <br /> 0 used on site ❑ Public <br /> 0 Other(specify) height measured from the <br /> 0 Other: (specify) 0 Commercial bottom of the footing to the top <br /> Total Cubic Yards 0 Industrial of the wall, even if it replaces <br /> 6.Sewage Disposal & an existing wall. <br /> ***Any earth movement may require 0 Other: (specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) 0 Public Sewer separated by twice the height <br /> 15320 Minnetonka Blvd ® Private Sewer of the higher wall. <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq j ® Private Well <br /> Estimated Construction Value $ 27.7 <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />