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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> MaYIOJi Application Salem,OR 97305 <br /> County Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> OREGON EXPIRED <br /> 555-21-002316-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Bethel Excavating <br /> PO Box 504 <br /> Turner, OR 97392 <br /> TYPE OF WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Commercial $0.00 <br /> Description of Work: MIN REPAIR REPL TANK WITH 2000 GAL FOR EXIST OFFICE(TAXLOT 801) <br /> SOB SITE INFORMATION '� ,��, <br /> Property Address: Parcel: Owner: LORI TINGLEY <br /> 10476 Sunnyside Rd Se,Jefferson,OR 97352 093W10A 00801 - Primary <br /> Address: PO BOX 70 <br /> JEFFERSON OR 97352 <br /> r yf P5 LICENSED PROFESSIONAL.INFORMATION <br /> Business Name License Address Phone <br /> BETHEL EXCAVATING Installer 36198 PO BOX 504 TURNER OR 97392 (50-3)-743- <br /> License <br /> m y PERMIT FEES r s� <br /> ,.w;•w ,, �, „�.t,`.. �„s�..n/ram-;...�,yii�.�o_ „�_,�.�....;� <br /> Fee Description Quantity Amount <br /> Repair(minor) - commercial facility 1.00 Ea $100.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $200.00 <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:03/08/2021 1 std_BuildingApplication_pr <br />