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MARION COUNTY <br /> �-� - Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> country Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> ORE G O,N <br /> 555-22-007866-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: PETERSON , LAUREL • <br /> 1072 BUNDY CT N <br /> KEIZER, OR 97303 <br /> ,Al... .n.�,. �,>- 2 4 rs_ -;4 at..�:;M U., e MA ....e ..>,-. _, r_. Wi4�, <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 4 BDRM RES <br /> 3 16A,. F -. Z . L :1 t , . •.,, 001-l3 iite NFO0A7 ON.. Zi7i4 '. 11 . 5µ , '" f M <br /> Property Address: Parcel: Owner: PETERSON,CHRISTOPHER C <br /> 4889 64Th PI Ne,Salem,OR 97305 072W04A 00100-Primary <br /> Address: 1072 BUNDY CT N <br /> KEIZER OR 97303 <br /> p _ w g ' , , LICENSED P ROFES ONA *i*oP: +MATION 3 _ ` t d <br /> Business Name License Address Phone <br /> a41 6,,:, v ,:00.4 h���ra� .. yx Fi' _ »., ay�.�'� AV ,s i� 1:: <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:0e/29/2022 1 std_BuildingApplication pr <br />