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MARION COUNTY <br /> i.IT�,S,�l�ily <br /> Building Application 5155 Silverton Rd NE <br /> fad Salem,OR 97305 <br /> frtio <br /> county 503-588-5147 <br /> Authorization NA <br /> FAX: 503-588-7948 <br /> ORE G ON <br /> 555-23-006833-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: HUBBARD LAKE HILLSIDE LLC <br /> 11122 WHEATLAND RD <br /> GERVAIS, OR 97026 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: AUTH TO REPL 3BD SFD W/3BD SFD <br /> Property Address: Parcel: Owner: HUBBARD LAKE HILLSIDE <br /> 2272 Matheny Rd Ne,Gervais,OR 97026 053W36 00900-Primary LLC <br /> Address: 11122 WHEATLAND RD <br /> k y r; LICENSED PROFESSIONAL INFOR[ ATIONC-4 GERVAIS OR 97026 <br /> Business Name License Address Phone <br /> . ;171;1_ ,..*1612.1:NOVSPZerdo . PERMIT`FEES' - ,r. <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $650.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $750.00 <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:08/10/2023 1 std_BuildingApplication pr <br />