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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> anion Salem,OR 97305 <br /> County 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-22-003955-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Lone Pine Corner Septics Inc. <br /> 8778 Cascade Hiahway. NE <br /> Silverton, OR 97381 <br /> [SMt 1v _ ' Nt x 1..V.E'i Cat6e*OA ;"' "g .,'e WR.jA <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 ALT: 3 BDRM SFD (P21-015, LOT:,1 OF 3) <br /> r.. w w .` .-.x -,. .. .,.. .:7 I i B SITE IL FORMMATIQI t� >r . .•, ° . . ,: . . �_. 1i ... <br /> Property Address: Parcel: Owner: BEREKOFF FAM LT <br /> 3857 Starlight Dr Ne,Silverton,OR 97381 071E07A 01400-Primary <br /> Address: 3857 STARLIGHT DR NE <br /> SILVERTON OR 97381 <br /> 3` LICENSED PROFESSIONAL'INFORMATI;t'3N , <br /> Business Name License Address Phone <br /> LONE PINE CORNER SEPTICS INC. Installer 37003 8778 CASCADE HIGHWAY,NE SILVERTON (50-3)-873- <br /> License OR 97381 <br /> M A �. PERM T <br /> Fee Description Quantity Amount <br /> Alteration (major) 1.00 Ea $675.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $775.00 <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:05/04/2022 1 std_BuildingApplication_pr <br />