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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion - Salem,OR 97305 <br /> County Authorization NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> ORE 6 b-N <br /> 555-20-008409-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: LARSON,LEIF <br /> PO BOX 516 <br /> GATES, OR 97346 <br /> 2 ? vas `Z" Axi .:; ' £' 2?a ,✓. TTP C woRK -�' r'es. Fv,Z dR i3, F,^ g R.. <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Manufactured Dwelling $0.00 <br /> Description of Work: FIRE-PRIMARY RES-AUTH MIN ALT: 3 BDRM TO REPL BURNT 3 BDRM NEEDS TO REPL CONTROL <br /> PANEL <br /> Property Address: Parcel: Owner: LARSON,LEIF <br /> 624 W Central Ave,Gates,OR 97346 093E27DC00300- Primary <br /> Address: PO BOX 516 <br /> s a. .- <br /> GATES OR 9 346 <br /> h,.:� x UCENS 3 PRO0i ±b ALI4aij*ATI*N R , IOit <br /> Business Name License Address Phone <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $450.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $550.00 <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:11/18/2020 1 std_BuildingApplication_pr <br />