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MARION COUNTY <br /> = � Building Application 5155 Silverton Rd NE <br /> Mer ._. Salem,OR 97305 <br /> Count) Permit NA FAX: 503 588 5147 <br /> 503-588-7948 <br /> Oi'R'E G 0 N <br /> 555-21-005066-PRMT <br /> www.co.rnarion.or.us building@co.marion.or.us <br /> Applicant: Groundbreaking Excavation, LLC <br /> PO BOX 670 <br /> LYONS, OR 97358 <br /> WO <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: 4 BDRM SFD (SIZED FOR 6) <br /> Property Address: Parcel: Owner: COOMBS CALEB&RENAE <br /> 3511 Memory Ln Se,Salem,OR 97317 083W25D 00501- Primary <br /> Address: 7636 BATTLE CREEK RD SE <br /> SALEM OR 97317 <br /> 0 0ESSIONAl4h"OaMATIONerl1.-___ .: <br /> Business Name License Address Phone <br /> GROUNDBREAKING EXCAVATION,LLC Installer 39191 7885 PARRISH GAP RD SE TURNER OR (40-6)-599- <br /> License 97392 <br /> 5g -� <br /> � Y <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface - by gallons per day 450.00 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:05/14/2021 1 std_BuildingApplication pr <br />