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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305503-588-5147 <br /> Plarzon <br /> County Site Evaluation NA FAX: 503-588-7948 <br /> O.R:E G O.N <br /> 555-24-005113-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: American On Site <br /> 31881 S Hwy 213 • <br /> Molalla, OR 97038-0857 <br /> �.,a ltf ,Y,. „`',: �',°;i..� r F z s �' �i 4 Fir. <br /> i<�«�`,%:- � � � ���r� � �� ` e � 'C1tP�1��WORK __,__�� ,� ���dq���� �� � <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> • Description of Work: SE: 4 BDRM SFD (REPL HOME IN NEW LOC) <br /> a4 ',,} a N A'f 9 t C• f # ti' T c rV' #"d ".. .:""'4k <br /> Property Address: Parcel: Owner: JASON AND ZORKA SALEEBY <br /> 20878 Hazelnut Ridge Rd Ne,Scotts Mills,OR 061E25 01200-Primary RLT <br /> 97375 Address: 20958 HAZELNUT RIDGE RD <br /> SCOTTS MILLS OR 97375 <br /> Business Name License Address Phone <br /> AMERICAN ON SITE Installer/Pu 38346 31881 S HWY 213 MOLALLA OR 503-209-7641 <br /> mper 97038-0857 <br /> License <br /> M fi WVIS uF '"' O ,'`CLt s T r r ? <br /> Fee Description Quantity Amount <br /> Site evaluation -Single family dwelling 1.00 Ea $890.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $990.00 <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:07/03/2024 1 std_BuildingApplication pr <br />