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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Ma rion Salem,OR 97305 <br /> County Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> o RI_G0:y' <br /> 555-23-009365-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: WILMES,JACOB DANIEL <br /> 6269 CHAMPOEG RD NE <br /> ST PAUL, OR 97137 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: NEW INSTALL FOR 4BDRM NSFD <br /> 14:145aka, �;+ ac 4 ., 7, <br /> � ^ <br /> �'�'., � � '��, .. � ,� , <br /> .4, � yF N"` 4-44 <br /> ; <br /> Property Address: Parcel: Owner: WILMES,JACOB DANIEL <br /> 10012 Champoeg Rd Ne,Aurora,OR 97002 041W07 00500-Primary <br /> Address: 6269 CHAMPOEG RD NE <br /> _ ST PAUL OR 97137- <br /> .. LIC .�a, R. QNA INF©I MA °. ,. ,w. ,.w .',.. ... ...ti_ <br /> Business Name License Address Phone <br /> PACIFIC NORTHWEST EXCAVATING, Installer 38846 PO BOX 61 WILSONVILLE OR 97070 503-329-5007 <br /> LLC License <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 450.00 GPD $1,050.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,150.00 <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 an:11/09/2023 1 std_BuildingApplication_pr <br />