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MARION COUNTY <br /> .�, Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> County 503-588-5147 <br /> Site Evaluation NA FAX: 503-588-7948 <br /> 0 R.EG' O.N <br /> 555-24-004641-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 /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: SE: 4 BDRM SFD FOR FUTURE PARTITION/PLA <br /> Property Address: Parcel: Owner: AC SERVICES LLC <br /> 7805 Wildberry Ln Se,Salem,OR 97306 083W26D001700-Primary <br /> Address: 4920 SW HOMESTEADER RD <br /> WILSONVILLE OR 97070 <br /> ;. . -.y LI ENSED PRO`E NAL INFO a O ° t : a ' ," ���4A S, <br /> Business Name License Address Phone <br /> -..�Fa-�, <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:06/18/2024 1 std_BuildingApplication_pr <br />