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MARION COUNTY <br /> -�,--•� Building Application 5155 Silverton Rd NE <br /> Nation Salem,OR 97305 <br /> Count. Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> Q:it;EG O N* <br /> 555-24-003060-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: SNEGIREV, KSENIA A <br /> 19602 BOONES FERRY RD NE <br /> HUBBARD, OR 97032 <br /> g,. `>'•Sv P,r°pg at ,,�s,�a,a »�'?P•<. -7 `. t „s,frf s <br /> f ,�r . . r .e u.. ra P C> *dk�il[[ ., a <br /> iaz.�� n-s<_„_= ..,.8.. ,,,;,..1��.� �r �..��„ .� Yf�4.a"` # s <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 5 BDRM SFD <br /> yux iWit, rift 3 ® E' <br /> Property Address: Parcel: Owner: SNEGIREV, KSENIA A <br /> 19571 Boones Ferry Rd Ne, Hubbard,OR 041W21 00900-Primary <br /> 97032 Address: 19602 BOONES FERRY RD <br /> NE <br /> HUBBARD OR 97032 <br /> u. H S, ixC>r{VSI C! PaC.IFESS O AL TNF+K R,MATIEyL1E ..-. r .,. > , <br /> Business Name License Address Phone <br /> SEE PROPERTY OWNER INFORMATION Owner OWNER <br /> Property <br /> r •' PE ,fteSie <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 1.00 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 on:04/18/2024 1 std_BuildingApplication pr <br />