2017-00256 - add bath where existing bedroom is

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. City of �rono Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY 3:, . � . p. .� ...-,. .. . .. . „ . ,..�. ,;. . . .,, . '�-� Mailing Address: �,JL�" i �O^,� Permit number. �i, ��-� _ + PO Box 66 V� ` Crystal Bay, MN 55323-0066 Date received: y�-� �-/�� �� , StreetAddress: �.� Received by: �'(� �`. �r + ^' 2750 Kelley Parkway ��)7 Plan review fee: ' �- � - , F � ; � � Orono, MN 55356 '}-. � � � � �� ��t s r i c�� _ T �a�Fee: / Main: 952-249-4600 Fax: 952-249-4616 �,��eF�;t��•i.or.�nc-��" ;�s This application form must be completed in full and all required information must be su mitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 2060 North Share Drive Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes �No !f yes, a special event permit is required with Po(ice Department and City Council approva!6Q days prior to the event. Shuttfe bus service will be required unless appficant demonstrates s�cient on-site parking is available. Non-permitted events will not be alfowed. CONTRACTOR 1 APPLICANT INFORMATION: Name: Dwellwell Design Ilc State License# BC636556 Expiration Date: 03/3112017 Lead Certification Number: Expiration Date: (for work on homes thai were consfructed prior to 1975 Phone: (cell) (612) 532-6046 (office) Mailing Address: PO BOX 1014 C� � ke ZIP: 55025 Contact Person: Dan Erickson Applicant is: Contractor / Homeowner (Clrcle One) Email and/or Fax: dan@dwellwelldesign.com PROPERTY OWNER INFORMATION: Name: Lyle Godfrey Phone (day): {952)473-3984 Address: 2060 Northshore Drive City: Orono ZIP: 55391 Email and/or Fax: Igodfrey�mchsi.com PROJECT INFORMATION: Overall project description: adding a bathroom where an existing bedroom is currently. ; Type of Project: Any earth movement may also require � MCWd review&permits: ❑ Door(s) �Remodel ❑ Fire Damage ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof, other(specify} ❑ Siding ❑Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 �/If1C�OW�S� u,'tn't4.�1f•,•��'.f'-c7}':2GC2@b�_G��u Estimated Construction Valuation of Project(excluding land) $ ao,000 APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant re�gnizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete; � • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confldential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which genera�ly cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If ou refuse to su I the inform � n the a lication ma not be issued. � Applicant's Signature: Date: 03/15/2017 Owner's Signature: t,,-. � Date: ��–/'� — /`� Last Updated:January 2016