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MARION COUNTY
<br /> Building Application 5155 Silverton Rd NE
<br /> Marion Salem,OR 97305
<br /> copy 503-588-5147
<br /> Permit NA FAX: 503-588-7948
<br /> OREG: ON
<br /> 555-22-007547-PRMT
<br /> www.co.marion.or.us building@co.marion.or.us
<br /> Applicant: Bethel Excavating
<br /> PO Box 504
<br /> Turner, OR 97392
<br /> $• tF r^a 3.�e"
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<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 FOR FUTURE 4 BDRM SFD
<br /> F 3 ,u JOB SIT IN,FORMATIO ).�d `.,�.. � ...
<br /> Property Address: Parcel: Owner: MONTOYA,KENNETH SCOTT
<br /> 1156 Hereford Way Se,Salem,OR 97317 072W34CA01001-Primary
<br /> Address: 4788 FORSYTHE DR SE
<br /> SALEM OR 97302
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<br /> Business Name License Address Phone
<br /> BETHEL EXCAVATING Installer 36198 PO BOX 504 TURNER OR 97392 (50-3)-743-
<br /> License
<br /> z FEES ' s 1 .
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<br /> Fee Description Quantity Amount
<br /> Install-Standard subsurface -by gallons per day 1.00 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:08/18/2022 1 std_BuildingApplication pr
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