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"•` a�.;;, MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> n Salem,OR 97305 <br /> County 503-588-5147 <br /> O t2 'G` <br /> Site Evaluation NA FAX: 503-588-7948 <br /> E O <br /> 555-24-004621-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: VERNON LACEY <br /> 23537 SANTIAM WAY SE <br /> LYONS, OR 97358 <br /> ��� 4' 54F" "� T``' �T '�• i �° ..mow tw �a"...,.: k's .;,x.;.- a �' ��.�^`—�s���i 5"� 'F 4 k� e <br /> ,..�€ as kP. ttl: it lC,,a 4 4 �> &v ada�� M' s x <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 FOR FUTURE 4 BDRM SFD <br /> r s sFr l *B,SITE. 0:T*AUAK � y ��� a M x ,,�, <br /> r?'sx",,,.. ...�i :�wd,.f-^�"5��'�,�� P<.,v�"'�ss�`.`.�"�'.„ .. ,w-,.wk�.,a,.a2-.�b. .. � -., - �„. � .a,.,,�_ �,n�, �...��twy,�r'�.a��a�«.r�...m� �.ss-�i�.T .�w.�r+�" �e.n�7 <br /> Property Address: Parcel: Owner: KERSEY,T KEITH&KERSEY, <br /> 23527 Santiam Way Se, Lyons,OR 97358 092E17AB01200- Primary ADENA ZOE <br /> Address: 17122 FERN RIDGE RD SE <br /> STAYTON OR 97383 <br /> 0: r: MF<. Mq-, LICENS D PI!ROFESSIONAL INFORMATION , : L_ .g . , ; <br /> Business Name License Address Phone <br /> A �i",� -'v ,p y l i 3 w n ,.� RP C <br /> �� � �. u. r .§.,urb'.-��'N:a ,r��.`�af3'�'� �,��., .,,. .. `��_ - ,!'^ER . <br /> Fee Description Quantity Amount <br /> Site evaluation-Single family dwelling 1.00 Ea $810.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $910.00 <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:06/17/2024 1 std_BuildingApplication_pr <br />