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,, MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> Marron.. <br /> county 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-21-009752-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: LUNDBERG,JEREMY&LUNDBERG, CASEY <br /> 12831 JEFFERSON HWY 99E SE <br /> JEFFERSON, OR 97352 <br /> ",._.. �� <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: NEW INSTALL: 4 BDRM SFD <br /> __ _ .tea ,. . ,. ,M � r SOB SITE INFORMATION <br /> Property Address: Parcel: Owner: LUNDBERG,JEREMY& <br /> 16407 Emerald Green Ln Se,Jefferson,OR 102W07C 00100- Primary LUNDBERG,CASEY <br /> 97352 Address: 12831 JEFFERSON HWY 99E <br /> SE <br /> JEFFERSON OR 97352 <br /> Et) I **,44 M IN.FORMATiot u j <br /> Business Name License Address Phone <br /> SEE PROPERTY OWNER INFORMATION Owner OWNER <br /> (Property) <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 450.00 GPD $750.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $850.00 <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:09/29/2021 1 std_BuildingApplication_pr <br />