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^"a MARION COUNTY <br /> Silverton Rd NE <br /> Building Application 5155 Salem,OR97305 <br /> ` 503-588-5147 <br /> i C° Authorization NA <br /> FAX: 503-588-7948 <br /> OREGON <br /> 555-21-003530-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> • <br /> Applicant: VERA DAVIS <br /> PO BOX 281 <br /> LYONS, OR 97358 L L <br /> , - �� 47'7A"$ o STYPE OF WORK rg��;,� ..�„„ — <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: FIRE-AUTH REPLACE 3 BDRM MD WITH 2 BDRM MD <br /> SOB SITZ W�ORMATION <br /> Property Address: Parcel: Owner: BERGBY,JAMES H <br /> 23405 Salmonberry Way Se, Lyons,OR 97358 092E17BD00301- Primary <br /> Address: PO BOX 281 <br /> LYONS OR 97358 <br /> IIENSa PRC) l»SSOD�IAI.IFCt /26 <br /> Business Name License Address Phone <br /> • <br /> , <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $450.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $550.00 <br /> Note:This may not include all the fees required for this project. <br /> This application will expire if application acceptance cannot be achieved within 180 days. <br /> All provisions of laws and ordinances governing this type of work will be complied with <br /> whether specified herein or not. <br /> All persons or entities performing work under this application are required to be licensed <br /> unless exempted by ORS 701.010. <br /> Printed on:04/07/2021 i std_BuildingApplication_pr <br />