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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Mario' Application Salem,OR 97305 <br /> County 503-588-5147 <br /> Site Evaluation NA FAX: 503-588-7948 <br /> 555-23-005540-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: LACKNER, KAREN L <br /> 23047 WAGNER LN SE <br /> LYONS, OR 97358 <br /> No Code Edition Specified <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 /> .� . aie: . jO..a J08:STTE_TNFORMAtio:si> .; it ° ° > tgos <br /> Property Address: Parcel: Owner: LACKNER, KAREN L <br /> 10234 Wagner Rd Se, Lyons,OR 97358 092E08 00900-Primary <br /> Address: 23047 WAGNER LN SE <br /> LYONS OR 97358 <br /> 10* _ a. LICENSED P1.4:00 10. AL:IkeOt ATIf3N , ; _t o gym. t , . :q $,SNZ <br /> Business Name License Address Phone <br /> ,;o-�.;ft�°a'� a� .�,� ° -� '� ��s ``sr. s_ � �yn <br /> yam,, PERMS SEES Q � , <br /> <», �, .�...�: .. .,.ass.,::do,s,. -. �. .a,".r.a . � ,��,�... „..._ .,... .,, �., -,, s x._ u,n,.o, l ie <br /> Fee Description Quantity Amount <br /> Site evaluation-Single family dwelling 1.00 Ea $725.00 <br /> DEQ Surcharge 1.00 - Automatic $100.00 <br /> Total Fees: $825.00 <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:06/2e/2023 1 std_BuildingApplication pr <br />