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;,,� ` • „;;� MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> /WHO,/ <br /> COU my 503-588-5147 <br /> Authorization NA FAX: 503-588-7948 <br /> OREGON <br /> 555-22-010453-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant:pp cant: 3A Construction, LLC <br /> 1690 Harvey St SE <br /> Jefferson, OR 97352 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: AUTH: 4 BDRM SFD TO REPL 2 BDRM SFD <br /> p <br /> ,;0 '^s,. ;','�s+� 9� s-',�, .,TNtat1 0 01 ATf'O _ -' ,��,,,. • s w � _ a.r�.k,� <br /> Property Address: Parcel: Owner: SMITH, DALE JR <br /> 8028 Jorgenson Ln Se, Salem,OR 97317 082W11D 03000-Primary <br /> Address: 8028 JORGENSON LN SE <br /> SALEM OR 97317 <br /> UcENS► PR0� 5S ONAL:INF RMxrIoN — ' ask <br /> Business Name License Address Phone <br /> 3A CONSTRUCTION,LLC Installer 39002 1690 HARVEY ST SE JEFFERSON OR 97352 (97-1)-218- <br /> License <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $605.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $705.00 <br /> Note:This may not include all the fees required for this project. <br /> • <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:11/16/2022 1 std_BuildingApplication_pr <br />