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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> :NationSalem,OR 97305 <br /> County Permit �A 503-588-5147 <br /> FAX: 503-588-7948 <br /> 0 R<E G O:N • <br /> 555-21-006090-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: HAZENBERG, BRANDON <br /> 5828 CHAMPOEG RD NE <br /> ST PAUL, OR 97137 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Manufactured Dwelling $0.00 <br /> Description of Work: NEW INSTALL ATT 3 BDRM MD <br /> P' <br /> Property Address: Parcel: Owner: HAZENBERG,HENRY <br /> 22427 River Rd Ne,St Paul,OR 97137 042W04 01000- Primary <br /> Address: 5828 CHAMPOEG RD NE <br /> ST <br /> . LICENSED PROFESS ONAL' INFORMATION; _ Y.._ OR 97.v ` <br /> PAUL137 <br /> Business Name License Address Phone <br /> Fee Description Quantity Amount <br /> Install-ATT-by gallons per day 1.00 GPD $990.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,090.00 <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:06/11/2021 i std_BuildingApplication pr <br />