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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> 17ar70t1 Salem,OR 97305 <br /> County 503-588-5147 <br /> Authorization NA <br /> FAX: 503-588-7948 <br /> OREGON <br /> 555-21-003362-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: NORTHWEST CUSTOM CONSTRUCTION INC <br /> PO BOX 3049 <br /> ALBANY, OR 97321 <br /> TYPE OF WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: AUTH: 2 BDRM SFD TO REPL 2 BDRM SFD <br /> JOB SITE INFORMATION <br /> Property Address: Parcel: Owner: SHOEMAKER, ROBERT <br /> 33682 Railroad Ave Se, Gates,OR 97346 093E25DC03600- Primary <br /> Address: 33682 RAILROAD AV SE <br /> GATES OR 97346 <br /> LICENSED PROFESSIONAL INFORMATION <br /> Business Name License Address Phone <br /> PERMIT FEES <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:04/01/2021 i std_BuildingApplication_pr <br />