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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> County 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-22-003959-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Ken Tooze Excavation, Inc <br /> PP <br /> 8624 Blackhawk Ct SE <br /> Salem, OR 97317 <br /> ,..�' _,r. .,.. .[: � -s, y £, a .-:s..o �:�.,. .nt,,'"a•.,�'u TYPE O f' OR1�.� -:� .. ,�.... _a -.,r ,�. ..m ,... <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: 4 BDRM SFD TO REPL 3 BDRM MH <br /> ' C 4 ; <br /> Property Address: Parcel: Owner: PETERS, DONNA <br /> 992 Iva Ln Ne,Salem, OR 97317 072W20D 01300- Primary <br /> Address: 992 IVA LN NE <br /> SALEM OR 97317 <br /> *4RON,MVISVAikftt:itt0:0:SEE*4*OtOST:64A(.i600,RM4#64.17anANtliNSIlinnlilll <br /> Business Name License Address Phone <br /> KEN TOOZE EXCAVATION,INC Installer 39231 8624 BLACKHAWK CT SE SALEM OR 97317 (50-3)-390- <br /> License �r <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 />