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4"4o MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Mar/art Salem,OR 97305 <br /> County; 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> 0'R,E G 0•N <br /> 555-21-00690.6—PRMT-01 <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: MELTON HOME REMODELING LLC <br /> PO BOX 918 <br /> MILL CITY, OR 97360 <br /> ... ,.,,.,.. ...... ... .... t��ra- J,S- � &. _.s' '"3 sh r xa 4,i ,�p1i <br /> d <br /> No Code Edition Specified <br /> Type of Work:- Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: FIRE MIN REPAIR D BOX REPL MANF HM W/3 BDRfM�MANFi�HM <br /> K 2 __W '`i4 3y°i O SITE INFORMAT!O h kqrnr ,- *3 a..ya.$3" <br /> Property Address: Parcel: Owner: BOX,ALTON S <br /> 10225 North Fork Ln Se, Lyons,OR 97358 093E11AB01000-Primary <br /> Address: 10225 NORTH FORK LN SE <br /> LYONS OR 97358 <br /> ; ` ' -n'Vysratei tS PEt+5Fi l ONAL INfiORMA CL "1... :P= <br /> Business Name License Address Phone <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:07/07/2021 1 std_BuildingApplication_pr <br />