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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem OR 97305 <br /> County 503-588-5147 <br /> Site Evaluation NA <br /> FAX: 503-588-7948 <br /> O R:E`G O;N <br /> • <br /> 555-23-005185-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: PLOWHEAD, JEREMY J &PLOWHEAD,ANGELA D <br /> 4196 ROBERTS RIDGE RD S <br /> SALEM, OR 97302 <br /> n x .' 3 �°.., ,r .r � ? p�sa'"^"" :a .� s "h am ,f-- .ak ,T '^" ' r: a <br /> s IF, L� ..° ° e :io ° ^tea s � T PEO NORKr^ zP vr .° � � � f� ; <br /> r.ik., �' -° .—,..o v.T h.,c ..°>° ..,... .- yc..� w n,-.n,..-9i <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 4 BDRM SFD(LOT2 OF 2 P 23-009) <br /> Property Address: Parcel: Owner: PLOWHEAD,JEREMY J& <br /> 4176 Roberts Ridge Rd S,Salem, OR 97302 TEMP MC-Primary PLOWHEAD,ANGELA D <br /> Address: 4196 ROBERTS RIDGE RD S <br /> SALEM OR 97302 <br /> Business Name License Address Phone <br /> ,PERMJtT FEES <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:06/16/2023 1 std_BuildingApplication pr <br />