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MARION COUNTY <br /> - - Building Application 5155 Silverton Rd NE <br /> al?Dt1 Salem,OR 97305 <br /> County 503-588-5147 <br /> Site Evaluation NA FAX: 503-588-7948 <br /> O.R.E G ON <br /> 555-24-006076-EVAL <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: WAGNER, GREGORY C <br /> 12122 FRY RD NE <br /> AURORA, OR 970002 <br /> .�';� � '' x�'�` � t�'+ ,�,t� as..s /yam^ /� l-° Frt� <br /> '" ` D a-i ,*,�,'.,. ' iRs- =ts ;°�,;,fi' k *PEsO skg:kkd"«.�,�, <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: SE: FUTURE 3 BDRM (REPL 3 BDRM MH IN NEW LOC) <br /> 4: ` ` a .. 10B SITE'INFORMATION. `, ;.s. �, ;: <br /> Property Address: Parcel: Owner: WAGNER,GREGORY C <br /> 12122 Fry Rd Ne,Aurora,OR 97002 041W21A 01400- Primary <br /> Address: 6210 SW LAKEVIEW BLVD <br /> LAKE OSWEGO OR 97035 <br /> t4 f;` LICENS D`P�ROFESSI.ONAL NFORMA`FION`�' �'a dfi m B�&£'. �k°"a'. "�$, , � -,.•es'A.r.P`e'�',-,_,..<,.<.av,... §. 4„.:,....,., , <br /> Business Name License Address Phone <br /> r. „ 4 r k <br /> Fee Description Quantity Amount <br /> Site evaluation-Single family dwelling 1.00 Ea $890.00 <br /> DEQ Surcharge 1.00 Automatic $117.00 <br /> Total Fees: $1,007.00 <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:oe/az/zoza 1 std_BuildingApplication pr <br />