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MARION COUNTY <br /> - • Building Application 5155 Silverton Rd NE <br /> HarlonSalem,OR 97305 <br /> - county. 503-588-5147 <br /> R <br /> Permit NA FAX: 503-588-7948 <br /> 0 E' <br /> 555-23-006799-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: WOOD STRUCTURE COMPONENTS NW LLC <br /> 445 SALEM HEIGHTS AVE S <br /> SALEM, OR 97302 <br /> F" PEO F WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: NEW INSTALL FOR 4 BDRM SFD <br /> Property Address: Parcel: Owner: <br /> 12061 Happy Way Se,Jefferson,OR 97352 093W14D 01900-Primary <br /> Address: <br /> Business Name License Address Phone <br /> GROUNDBREAKING EXCAVATION,LLC Installer 39191 PO BOX 670 LYONS OR 97358 503-884-6296 <br /> License <br /> ' E ;. . ` <br /> `gym ¢ € ..._:�.:. ... . .�ERlb�FE.. .,S'.x.�. :' ��;5 <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 350.00 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:08/0e/2023 1 std_BuildingApplication pr <br />