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MARION COUNTY
<br /> Building Application 5155 Silverton Rd NE
<br /> Salem,OR 97305
<br /> county Authorization NA FAX: 503-588-7948
<br /> OREGON
<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
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<br /> Property Address: Parcel: Owner: ELLIS,HAROLD L JR
<br /> 210 Butte St N, Detroit,OR 97342 105E018C09200- Primary
<br /> Address: 210 BUTTE ST N
<br /> DETROIT OR 97342
<br /> ' ` g rF, , ICENSED PROFESSIONAL,INFi TIO WS - -# � -
<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 tY �f +
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<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 /> s.
<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
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