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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Mt10 Salem,OR 97305 <br /> coun Authorization NA • <br /> 503 588 5147 <br /> FAX: 503-588-7948 <br /> O'R E G'O N <br /> 555-22-005329-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: JACOBSEN LT&JACOBSEN, RANDY N TRE <br /> 151 WILDFLOWER LN <br /> SILVERTON, OR 97381 <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 W/FLD REPL 2 BDRM WITH NSFD 2 BDRM/2 BATH <br /> 7. 1„ <br /> Property Address: Parcel: Owner: JACOBSEN LT&JACOBSEN, <br /> 24023 Patton Loop Se,Lyons,OR 97358 092E16BC00600- Primary RANDY N TRE <br /> Address: 151 WILDFLOWER LN <br /> SILVERTON OR 97381 <br /> AIE TIU4 <br /> Business Name License Address Phone <br /> SEE PROPERTY OWNER INFORMATION Owner OWNER <br /> Pro ert <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:06/15/2022 i std_BuildingApplication_pr <br />