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„, MARION COUNTY <br /> ~�= Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> Co 503-588-5147 <br /> Authorization NA FAX: 503-588-7948 <br /> O"REGOrN <br /> 555-21-007968-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: HARROLD, DON <br /> 8502 ASHDOWN CT SE <br /> SALEM, OR 97301-9091 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: FIRE-AUTH TO REPL 1 BDRM SFD WITH 2 BDRM SFD <br /> Property Address: Parcel: Owner: ELKHORN CORP <br /> 34885 North Fork Rd Se Bldg A,Stayton,ORE 084E31 00100- Primary <br /> 97383 Address: 2009 NE BRAZEE <br /> PORTLAND OR 97212 <br /> ,,.t, LICENSED PROFESSIONAL;INF O R M ATION :N <br /> Business Name ' License Address Phone <br /> PENT FEES <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $450.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $550.00 <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:08/05/2021 1 std_BuildingApplication pr <br />