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" MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> MaYIOIZ Salem,OR 97305 <br /> County Inquiry NA 503-588-5147 <br /> q rY FAX: 503-588-7948 <br /> OREGO,N' <br /> 555-24-006448-INQY <br /> www.co.marion.or.us building@co.marion.or.us <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: ESE: 3 BDRM SFD (PLA 22-029) <br /> ;IA AglingiereilIWAlgt- <br /> Q SIT TNFQIRMAfI© ' <br /> .¢3.:. _. .. ..... - tea:; '., ' <br /> ntige <br /> Property Address: Parcel: Owner: DORIS M BARTOSZ LT <br /> 10443 West Stayton Rd Se,Aumsville,OR 092W12 01200-Primary <br /> 97325 Address: 41670 ISLAND DR SE <br /> _ STAYTON OR 97383 <br /> > CENSED PROF SSTONA tNF A'ZO Mr& <br /> Business Name License Address Phone <br /> Viapikivetbitm <br /> PIE �FE St. ., y.tr %0 x. ' r esrMA <br /> Fee Description Quantity Amount <br /> Existing system evaluation report 1.00 Ea $650.00 <br /> DEQ Surcharge 1.00 Automatic $117.00 <br /> Total Fees: $767.00 <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:08/15/2024 1 std_BuildingApplication_pr <br />