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MARION COUNTY <br /> ,.,neAtaro�a� <br /> Building Application <br /> 5155 Silverton Rd NE <br /> Salem,OR97305 <br /> Mc?I'ir071�" <br /> CO/ally 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> O R.E G O.N <br /> 555-21-010305-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Mike Hamer, Inc. <br /> 32948 Brewster Road <br /> Lebanon, OR 97355 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MIN REP to REPL TANK <br /> JOB SITE INFORMATION' <br /> Property Address: Parcel: Owner: MARTICHUSKI,JAMES C <br /> 5584 Mark Ct Se,Salem, OR 97317 083W13DA02100-Primary <br /> Address: 5584 MARK CT SE <br /> SALEM <br /> OR 97317 <br /> LICENSED PROFESSIONAL INFORMATION <br /> Business Name License Address Phone <br /> MIKE HAMER,INC. Installer 37908 32948 BREWSTER ROAD LEBANON OR (54-1)-990- <br /> License 97355 <br /> PERMIT FEES <br /> Fee Description Quantity Amount <br /> Repair(minor) -single family dwelling 1.00 Ea $100.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $200.00 <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:10/13/2021 1 std_BuildingApplication pr <br />