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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> M _ Salem,OR 97305 <br /> ai7Countil Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> O: R:ECON <br /> 555-20-008243-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Torry L Collins, Inc <br /> P.O. Box 962 <br /> Molalla, OR 97038 <br /> .... :.,. <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: NEW INSTALL: 3 BDRM SFD <br /> R .T ',.,-.' 7OB SITE INFQRM/4TI N a . <br /> Property Address: Parcel: Owner: RODRIGUEZ,JOSE <br /> 997 Iva Ln Ne,Salem,OR 97317 072W20D 02301- Primary RODRIGUEZ <br /> Address: 4852 WHITEWATER ST NE <br /> SALEM 97305 <br /> OR <br /> �; .. _. 6 LICENS E PROFTS5Io AC INFD,RMATwN <br /> Business Name License Address Phone <br /> TORRY L COLLINS,INC Installer 37956 P.O.BOX 962 MOLALLA OR 97038 (50-3)-689- <br /> License <br /> - _ _ _ RERIKT.T FEES <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 1.00 GPD $750.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $850.00 <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:11/13/2020 1 std_BuildingApplication pr <br />