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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> frfarion <br /> GOuizt.y Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> oREGO.N' <br /> 555-21-006449-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Oregon Sewer&Drain <br /> PO Box 1282 <br /> Silverton, OR 97381 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MA] REP 2 BDRM SFD �: <br /> •• a B S! TI, i�[ � <br /> Property Address: Parcel: Owner: KUENZI,LEON D <br /> 7964 Labish Center Rd Ne,Salem,OR 97305 062W26 00400- Primary <br /> Address: PO BOX 9026 <br /> BROOKS OR 97305 <br /> L P t; ROFESS "OsNA INFOATI OMO i'1al 41. <br /> .3u Knd- &:ar-mamdsmm,�m- <br /> Business Name License Address Phone <br /> OREGON SEWER&DRAIN Installer/Pu 38968 PO BOX 1282 SILVERTON OR 97381 (50-3)-874- <br /> m.er License <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:oe/zz/zozi 1 std_BuildingApplication�r <br />