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4" zi MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> 811DYt Salem,OR 97305 <br /> County Site Evaluation NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> Qr R.E•G: O.F1 <br /> 555-24-004642-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 /> F gitrt �9_.' `aNf�Y, P .,� *r^..n 71 q*7 �•aF�ar�.�g��^�°�.��e�•.F.,. r�+.�.�,a+ c F ;JA' :;.`§'R` OTTYIitg 8 's:;., A PVf: t <br /> No 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 /> a >, . f :tom , OB SI.TEfINFORMATION r, <br /> Property Address: Parcel: Owner: AC SERVICES LLC <br /> 7845 Wildberry Ln Se,Salem,OR 97303 083W26D 02300-Primary <br /> Address: 4920 SW HOMESTEADER RD <br /> WILSONVILLE OR 97070 <br /> �' `7 �"�g `' «.�wy �r y, r t..�v'tw y:�O .Y ,CO, ,L: F r �r ,� .`+F, a;' 'r �,: <br /> •a 3 . ., a �,•�fir', �"- z;OetN,c s *fCtO ,NAt.s ae -., QI�i.,a•�A- '� �'.:e ;a .�ea'i .. �e s�..a«.`,a.�` <br /> Business Name License Address Phone <br /> .h . - .. ,, PERMIT FEES j£ -S•, <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/zoza 1 std_BuildingApplication_pr <br />