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- <br /> • <br /> "n MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> 1a1?Dn Salem,OR 97305 <br /> • County Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> O.R.E G. 0.N <br /> 555-24-004251-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Ken Tooze Excavation, Inc <br /> 8624 Blackhawk Ct SE <br /> Salem, OR 97317 <br /> "� � � �tn, s +"�2 rd� a zx�,cA 6C� a�Y��e��r r �z.ram ,;� *a , "'s�``�, <br /> g„ ..3�,,.f .F.,r,`:.�,��r.r,.$8;a yf fiy ,— EF 'n ` TYPE�;OFWORR ,�..r, .R., ,rf , �,�. �.. .., _r 6.� K,x,^n, x,.. txi....�.� , <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MIN REP: REPL TANK IN SAME LOCATION <br /> „„ .<a __, %.w. UM _y NARK .r'$ Y b dR S 01` #10, V t< , t ,. .0:11 51W. lagi ,., S'e <br /> Property Address: Parcel: Owner: KING,ANNA A <br /> 115 Maple St,Gates,OR 97346 093E26C600700-Primary <br /> Address: 12001 CHANTAL ST <br /> DONALD OR 97020 <br /> .`.. . ,. . ., . F> LICENS PROFESSONALINFORMATION `W n i y ;' <br /> Business Name License Address Phone <br /> KEN TOOZE EXCAVATION,INC Installer 39231 8624 BLACKHAWK CT SE SALEM OR 97317 503-390-0510 <br /> License ffC i� �+L� �+ <br /> b�'� b PERIMIT.]FEES .,.� .x .��➢ , _;r �ay' ,kg ',a <br /> 9� <br /> �s <br /> Fee Description Quantity Amount <br /> Repair(minor) -single family dwelling 1.00 Ea $320.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $420.00 <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:06/03/2024 1 std_BuildingApplication_pr <br />