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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion ion Salem,OR 97305 <br /> Country 503-588-5147 <br /> Authorization NA FAX: 503-588-7948 <br /> O R.EG:ON <br /> 555-23-004442-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Shafer, Daniel <br /> 8044 Wheatland Rd. N <br /> Keizer, OR 97303 <br /> 9 lbsd2g iw...ro__-r viAA.4: .&uv✓'Y,s� C; C � ..{* w. ;....dw' "� f w.,...k..a�' a�:�. �., �/i'.............. 5 a <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: FIRE-AUTH: REPL BURNED 3BD SFD WITH 3BD SFD <br /> ran , , <br /> ..,_ Md Sal' Ri++ll�►TIC N',p 141. . ...... <br /> Property Address: Parcel: Owner: DEATLEY,JAMES W(LE) <br /> 22988 North Fork Rd Se, Lyons,OR 97358 092E17BC01600-Primary <br /> Address: 1705 CHEMEKETA ST NE <br /> SALEM OR 97301 <br /> LICEp`� Imo' r - �[�F T ; <br /> ,.,.. � I ,C1:,„„ „`�C.t}w,K ",. �dN <br /> Business Name License Address Phone <br /> DEQ M466 8044 WHEATLAND RD.N KEIZER OR 97303 (97-1)-600- <br /> Installer/Mai <br /> ntenance <br /> Provider <br /> rg <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $605.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $705.00 <br /> Note:This may not include all the fees required for this project. <br /> • <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:05/25/2023 1 std B I.diingApplication pr <br />