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MARION COUNTY <br /> -= =~ Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> county 503-588-5147 <br /> Site Evaluation NA FAX: 503-588-7948 <br /> O:REG°O.N <br /> 555-24-004569-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: LEAR,THOMAS C&LEAR, AMY L <br /> 7957 STAFNEY LN NE <br /> GERVAIS, OR 97026 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: SE/ESE FOR PLA 24-007 AND REPLACEMENT <br /> Property Address: Parcel: Owner: LEAR,THOMAS C&LEAR, <br /> 7957 Stafney Ln Ne,Gervais,OR 97026 052W11C 00400-Primary AMY L <br /> Address: 7957 STAFNEY LN NE <br /> GERVAIS OR 97026 <br /> Business Name License Address Phone <br /> ' ''s „a• $�� 1,8 t � s�c,0 4 spa 2�'a+ sZ `' za°«°^z, y'' �y �'T to ERM T #ax r k £a y�� r �s �y k , <br /> s��,1„m� .,.�'v�i.; .3 ;t 'r i 't :' x- I/ .i000$..., Gkgwo c,.,. vi e: s S m/t i m,k. s . i� <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:06/14/2024 1 std_BuildingApplication_pr <br />