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MARION COUNTY <br /> {=• Building Application 5155 Silverton Rd NE <br /> Mafia? Salem,OR 97305 <br /> County 503-588-5147 <br /> Site Evaluation NA FAX: 503-588-7948 <br /> O R.E G:O.N <br /> 555-23-005539-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: LACKNER, JEROME P <br /> 23047-WAGNER LN SE <br /> LYONS, OR 97358 <br /> i;' ram' *�, `'�� �- �✓ /x ✓ >,:. <br /> No Code Edition Specified <br /> • <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling -. $0.00 <br /> Description of Work: SE: FUTURE 3 BDRM SFD <br /> f'.gym .✓r `✓^ ," g'✓ ;s ENN� �JOB!*IT INFO MATO �,.�. .°� <.a3s <br /> ° �,�.. ;.���:u���RPM ��.��. _ . � ° -� <br /> Property Address: Parcel: Owner: LACKNER,JEROME P <br /> 10244 Wagner Rd Se, Lyons,OR 97358 092E08 00800- Primary <br /> Address: 23047 WAGNER LN SE <br /> LYONS OR 97358 <br /> # 'LICENS D PROFESSIONA INFO MATIO111 9' <br /> Business Name License Address Phone <br /> -_d h, •v ��.•u' r°+n .«� l d PERMIT�FEES 5bl5�` F°;iW�"s✓ 9' 1, N. &en^ F as�i� °sk'm° <br /> �-.s° <, ,a-.aa,.,.�:,�,d�.��✓��E��r,v ,�,,.�a as<E � ,.°. ^�,,,�"<.,�„ ,."�e�.��..�" ✓; ..� � _ ��a�`�2°w�d°���,' <br /> Fee Description Quantity Amount <br /> Site evaluation-additional lots 1.00 Ea $670.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $770.00 <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:06/28/2023 1 std_BuildingApplication pr <br />