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.Mks„,1/4; MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> County Permit NA 503-588-5147 <br /> FAX:-503-588-7948 <br /> ORE G: O.N <br /> 555-21-008684-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Modine Construction, Inc <br /> 5237 Chehalis Dr N <br /> Salem, OR 97303 <br /> i . -, A ..., k„ Ni .h# i 'lWPE OF WORK os _.. _ ng ..5 <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 MAJ REP: 2 BDRM SFD TO REPL 2 BDRM SFD <br /> V VI A M .r ....,._. 1OB�SITE,IN_FORMATION:';,., r,, V: V K R ear fO <br /> Property Address: Parcel: Owner: ROANTREE,MICHAEL L <br /> 23980 Summerhaven Dr Se, Lyons,OR 97358 092E16BC00300-Primary <br /> Address: 23980 SUMMERHAVEN DR <br /> SE <br /> LYONS OR 97358 <br /> LICENS t PROFESSI~ONAL T JFORM 1TION :ramk .f. <br /> Business Name License Address Phone <br /> MODINE CONSTRUCTION,INC Installer 39331 5237 CHEHALIS DR N SALEM OR 97303 (50-3)-302- <br /> License <br /> Fee Description Quantity Amount <br /> Repair(major) -single family dwelling 1.00 Ea $600.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $700.00 <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:08/27/2021 1 std_BuildingApplication pr <br />