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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> County Permit NA 503 588 5147 <br /> FAX: 503-588-7948 <br /> O R E G O N <br /> 555-22-000657-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: J.A. Holland Construction <br /> 4946 Waaon Trail CT SE <br /> Salem, OR 97317 <br /> TYPE OF WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MA] REPAIR EXIST 3 BDRM RES <br /> i <br /> JOB SITE INFORMATION , , <br /> Property Address: Parcel: Owner: GAUSE LT&GAUSE, <br /> 17085 Wall Ln Se,Jefferson,OR 97352 103W13AA00300 - Primary ALBERTINE J THE <br /> Address: 17085 WALL LN SE <br /> JEFFERSON OR 97352 <br /> LICENSED PROFESSIONAL INFORMATION <br /> Business Name License Address Phone <br /> J.A.HOLLAND CONSTRUCTION installer 39439 4946 WAGON TRAIL CT SE SALEM OR (54 1)-378- <br /> License 9731/ <br /> j r, 1,46'AWMPOM PERMIT FEES <br /> Fee Description Quantity Amount <br /> Repair(major) -single family dwelling 1.00 Ea $600.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $700.00 <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:01/24/2022 i std_BuildingApplication_pr <br />