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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> Martin 503-588-5147 <br /> County <br /> Site Evaluation NA FAX: 503-588-7948 <br /> OR,E G'ON <br /> 555-24-004643-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: AC SERVICES LLC <br /> 4920 SW HOMESTEADER RD <br /> WILSONVILLE, OR 97070 <br /> 11 �4 �l TYPI OF WORK <br /> .s,<, 5,�.../9, gr A,6.1 �„d°w.;. ,,.�ee�;�.g„ .,. sv, '-TYfuA:G:r�u8�i1u�.uNo Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: SE: 4 BDRM SFD FOR FUTURE PARTITION/PLA <br /> #LS: Ik dvw w,.,m»...,w ,A:2WfU. itilt9O-S' 0:44 IRa€.. N x. ,y;-.r , A O "f e 2'.s€.d«m.. <br /> Property Address: Parcel: Owner: AC SERVICES LLC <br /> 7825 Wildberry Ln Se,Salem,OR 97306 TEMP MC-Primary <br /> Address: 4920 SW HOMESTEADER RD <br /> WILSONVILLE OR 970700 t <br /> Business Name License Address Phone <br /> e og*i W � PERMIT FEES! 4 t <br /> Fee Description Quantity Amount <br /> Site evaluation-additional lots 1.00 Ea $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:06/18/2024 1 std_BuildingApplication_pr <br />