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MARION COUNTY <br /> Building Application 5155Silverton Rd NE <br /> Marlon,_ Salem,OR 97305 <br /> County 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> O R.E`G O N <br /> 555-23-001336-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: ANDERSON, MARK] &ANDERSON, CATHERINE M <br /> 21579 CHAMPOEG CREEK LN NE <br /> ST PAUL, OR 97137 <br /> g r <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Commercial $0.00 <br /> Description of Work: NEW INSTALL: FARM OFFICE(3 EMPL) <br /> : JOB SITE INFORMATION �' �k'. <br /> Property Address: Parcel: Owner: ANDERSON,MARK]& <br /> 21573 Champoeg Creek Ln Ne,St Paul, OR 042W12 01300- Primary ANDERSON,CATHERINE M <br /> 97137 Address: 21579 CHAMPOEG CREEK <br /> LN NE <br /> ST PAUL OR 97137 <br /> ';LICENSED PROFESSIONAL,INFORMATION.. <br /> Business Name License Address Phone <br /> PERMIT:,FEES " ' a . a <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 150.00 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:02/10/2023 1 std_BuildingApplication pr <br />