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MARION COUNTY <br /> Building Application 5155 suverton Rd NE <br /> Salem,OR 97305 <br /> COut2ty 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> '0.k;E.G.0 t4 <br /> • <br /> 555-23-007984-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: KAUFFMAN,ADRIAN STANLEY JR KAUFFMAN,TIMOTHY DANIEL <br /> 1768 NE BELL DR <br /> PORTLAND, OR 97220 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: FIRE MAJ REP: 3 BDRM SFD <br /> Property Address: Parcel: Owner: KAUFFMAN,ADRIAN <br /> 110 Mackey Ln E, Detroit,OR 97342 105E01DC03000-Primary STANLEY JR KAUFFMAN, <br /> TIMOTHY DANIEL <br /> Address: 19756 OLMSTEAD RD NE <br /> E1 AURORA OR 97002 <br /> ki A '. <br /> Business Name License Address Phone <br /> SEE PROPERTY OWNER INFORMATION Owner OWNER <br /> (Property <br /> «..... <br /> Fee Description Quantity Amount <br /> Repair(major) -single family dwelling 1.00 Ea $640.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $740.00 <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:09/22/2023 1 std_BuildingApplication pr <br />