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I; ,„row MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> 1r1anon Salem,OR 97305 <br /> County 503-588-5147 <br /> • <br /> Authorization NA FAX: 503-588-7948 <br /> O.R.EG O,N <br /> 555-22-005828-AUTH <br /> www.co.marion.or.us building©co.marion:or.us <br /> Applicant: JACKSON COMMERCIAL CONST <br /> PO BO X3912 <br /> SALEM, OR 97302 <br /> -I__ <br /> r � � VR m" Cm'�.• . <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: AUTH-REPLACE BDRM SFD WITH 4 BDRM SFD <br /> ��5 y " JAB'S x€ IN gORMAT.4 D �"� 4�h T "-': ""�z <br /> � a� _ .ma's • .. . ..._ ., � ��,.�� ?'� �•� � _ <br /> Property Address: Parcel: Owner: HENDREN, DARREN A& <br /> 5515 Serenity Dr Se,Salem,OR 97317 083W13DB00400-Primary HENDREN,SARAH M <br /> Address: 5515 SERENITY DR SE <br /> SALEM OR 97317 <br /> L:TCE_,l $ CRC1=S �NALTNC3EIATIO,.. a .,: � .� <br /> Business Name License Address Phone <br /> ��„. �d. '' �t �":�-�, k v s �. g � ���5 ar y�. E'" <br /> ,. � Ar3;;: .. ..,..,,.a„� x`w e M.... , .... e .f a....,PER F Ir _ ;::.:'��..:21, ,a�'. t �',.xiw. .-:s. r..�. M141.r1+�v � a^ , <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $605.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $705.00 <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:07/01/2022 1 std_BuildingApplication pr <br />