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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> NationSalem,OR 97305 <br /> county 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-23-009984-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: ENGLISH, ZACHARY D <br /> 4275 ]ACKPIINE ST NE <br /> SALEM, OR 97305 <br /> � M 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: REINSTATE 22-005281-PRMT-NEW INSTALL 4 BDRM <br /> clr' ' �+� a'',:P,•� ..� �+ � s��>.�.. <br /> Property Address: Parcel: Owner: ENGLISH, ZACHARY D <br /> 2664 Bodhi Ln Ne, Salem, OR 97305 072W13C800701 - Primary <br /> Address: 4275 JACKPIINE ST NE <br /> SALEM OR 97305 <br /> LICENSED PROFESSIONAL I ,,MATION <br /> Business Name License Address Phone <br /> LONE PINE CORNER SEPTICS INC, Installer 3700 3 8778 CASCADE HIGHWAY, NE SILVERTON 503-873-7157 <br /> License CR 9'381 <br /> PERMIT FEES <br /> Fee Description Quantity Amount <br /> Permit transfer, reinstatement or renewal-no field visit 1.00 Ea $35.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $135.00 <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: 12/11/2023 1 std_BuildingApplication_pr <br />