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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> Countrf. Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> O R E`..G:O, N <br /> 555-23-007173-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Micah Hozen <br /> 1797 Winston Section Rd <br /> Winston, OR 97496 <br /> d�k _ *� 1%'" ark v .mot$=e% .,�� <br /> � 1 � T1fP OF.eWORtC g?. . <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MIN REP: 3 BDRM SFD <br /> � s �z�p j rPy� '4s a ® SIT INFORMATION'%r� st's -� �yy''z' p, <br /> Property Address: Parcel: Owner: HOSFORD,THOMAS M <br /> 13453 Marlatt Rd S,Jefferson, OR 97352 093W30A 02700- Primary <br /> Address: 13453 MARLATT RD S <br /> JEFFERSON OR 97352 <br /> CENS m ROFESSXONAL INFORMA <br /> Business Name License Address Phone <br /> MICAH HOZEN Installer 38988 1797 WINSTON SECTION RD WINSTON OR 503-710-2565 <br /> License 97496 <br /> c <br /> s. ` '. FEES 1 0 <br /> Fee Description Quantity Amount <br /> Repair(minor) -single family dwelling 1.00 Ea $320.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $420.00 <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:08/23/2023 1 std_BuildingApplication pr <br />