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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> Marion <br /> County 503-588-5147 <br /> Authorization NA <br /> . AX: 503 588 7948 <br /> OREGON <br /> hom <br /> 555-21-000669-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: BUSH,DARRELL <br /> 131 LOUISA ST <br /> GATES, OR 97346 <br /> i <br /> TYPE OF WORK 5 .i._::�,.r ke -.ti„ ;" - <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: FIRE -AUTH REPLACE 3 BDRM MD WITH SAME <br /> JOB SITE INFORMATION <br /> IL R."_c. <br /> Property Address: Parcel: Owner: BUSH,DARRELL <br /> 131 Louisa St, Gates, OR 97346 093E27DD03600 - Primary <br /> Address: 131 LOUISA9 ST <br /> GATES OR 97346 <br /> LICENSED PROFESSIONAL INFORMATION <br /> Business Name License Address Phone <br /> PERMIT FEEStil _.. <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:01/25/2021 i std_BuildingApplication_pr <br />