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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion <br /> SaleYn,OR 97305 <br /> 503-588-5147 <br /> County <br /> Site Evaluation NA FAX: 503-588-7948 <br /> OREGON' <br /> 555-23-008849-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: KENT KAUFMAN - KAUFMAN HOMES <br /> 5797 STATE ST SE <br /> SALEM, OR 97317 <br /> � ,., _&: . :A. . <br /> No Code Edition Specified <br /> Type of.Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> A. Description of Work: SE FOR FUTURE 4 BDRM SFD <br /> E INFORMAT* <br /> Property Address: Parcel: Owner: DOUBLE K HOLDINGS LLC. <br /> 2821 Forest Haven Way S,Salem,OR 97302 083W08B 01400-Primary <br /> Address: 5797 STATE ST <br /> SALEM OR 97317 <br /> .KK ' 'LICENSED PRo s ONA °INFO A`GIOPC. <br /> Business Name License Address Phone <br /> 44 at'4 1 a cI y19� � p :4::r a ��'e- <br /> 11 <br /> Fee Description Quantity Amount <br /> Site evaluation-Single family dwelling 1.00 Ea $810.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $910.00 <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:10/20/2023 1 std_BuildingApplication_pr <br />