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;,,, MARION COUNTY <br /> ° Building Application 5155 Silverton Rd NE <br /> ===^ Salem,OR 97305 <br /> 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-21-010192-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: WISE, HEIDI L&WISE, MICHAEL D <br /> 3495 BERGMAN PL SE <br /> SALEM, OR 97317 <br /> .,_TYPE DF WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MAJ REP: 3 BDRM <br /> ...__ �.. 'i,JOB SITE II FORMATION[ <br /> Property Address: Parcel: Owner: WISE, HEIDI L&WISE, <br /> 3495 Bergman PI Se,Salem,OR 97317 082W30 00500- Primary MICHAEL D <br /> Address: 3495 BERGMAN PL SE <br /> OC MATION-; I_IGENSE[3 PROFES,SIONAL3NF r ,�. _ <br /> Business Name License Address Phone <br /> SEE PROPERTY OWNER INFORMATION Owner OWNER <br /> (Property) a w_ __ <br /> Fee Description Quantity Amount <br /> Repair(major)-single family dwelling 1.00 Ea $600.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $700.00 <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:10/08/2021 i std_BuildingApplication_pr <br />