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„frIk^-- - MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> county 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-23-008223-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Dwain Bethel &Sons Excavation, Inc. <br /> PO Box 504 <br /> Turner, OR 97392 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: MIN ALT,ADD TANK FOR SHOP <br /> �: "d as , <br /> T �* L� Fes. �1 <br /> , ^ 7 ,,,>>:.. a s�.;� 10:Bi SITE' IFORMkATION 4: - ,,. <br /> Property Address: Parcel: Owner: WHITELEY JRLT <br /> 15192 Libby Ln Se,Jefferson,OR 97352 102W05 00100-Primary <br /> Address: 15192 LIBBY LN SE <br /> JEFFERSON OR 97352 <br /> '44 ... ,.w �i CENSER PR.O, v 0�, A INFO .TIO nu .. «. <br /> Business Name License Address Phone <br /> DWAIN BETHEL&SONS EXCAVATION, Installer 36198 PO BOX 504 TURNER OR 97392 503-743-2343 <br /> INC. License <br /> 4 ''4114,~, T FEES ;,�,.. , <br /> 5. ��.., :�.�.:� �<� ;�, , PERML � ems- , . <br /> Fee Description Quantity Amount <br /> Alteration (minor) 1.00 Ea $440.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $540.00 <br /> Note:This maynot include all the fees required for this project. <br /> 9 P I <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:09/28/2023 1 std_BuildingApplication_pr <br />