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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Mat?fl11 Salem,OR 97305 <br /> County 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> O RE G: ON <br /> 555-22-009111-PRMT <br /> www.co.marion.or.us building@co:marion.or.us <br /> Applicant: TIFFANY GWINN <br /> 5544 54TH CT SE <br /> SALEM, OR 97317 <br /> - ne *#, ., �,�""` -'-, <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 RES <br /> Property Address: Parcel: Owner: <br /> 5540 54Th Ct Se,Salem,OR 97317 TEMP MC-Primary <br /> Address: <br /> ? as _' ;': "':. *o m <br /> -� L ICENSED FROFESSIONA TNFOR, TIo__ <br /> Business Name License Address Phone <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 450.00 GPD $1,010.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,110.00 <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:10/04/2022 1 std_BuildingApplication pr <br />