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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Nation Salem,OR 97305 <br /> County <br /> 503-588-5147 <br /> Authorization NA FAX: 503-588-7948 <br /> oil:E G OrN <br /> 555-21-008282-AUTH <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: FIRE-AUTH 1 BDRM SFD to REPL 1 BDRM <br /> Property Address: Parcel: Owner: ELLIS,HAROLD L JR <br /> 210 Butte St N,Detroit,OR 97342 105E01BC09200- Primary <br /> Address: 210 BUTTE ST N <br /> DETROIT OR 97342 <br /> _ _. .. t .. Z LICENSED PROFESSIONAL INFORMATION M .il* , ,qv.. ?f i'#fi <br /> Business Name License Address Phone <br /> OREGON SEWER&DRAIN Installer/Pu 38968 PO BOX 1282 SILVERTON OR 97381 (50-3)-874- <br /> mper <br /> License <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $450.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $550.00 <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:08/16/2021 1 std_BuildingApplication pr <br />