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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> Nation <br /> county Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> O.REGON <br /> 555-22-003071-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: FINK, RONALD W &PICARD, KEELY RAE <br /> 1539 SILVER FALLS DR NE <br /> SILVERTON, OR 97381 <br /> .77 ^o. .v <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: NEW INSTALL 4 BDRM RES <br /> i tg fzA7S JOB SITE INFORMATION ,a 9 t a °' <br /> Property Address: Parcel: Owner: FINK, RONALD W&PICARD, <br /> 1569 Silver Falls Dr Ne,Silverton,OR 97381 071E21B 00501-Primary KEELY RAE <br /> Address: 1539 SILVER FALLS DR NE <br /> • <br /> SILVERTON OR 97381 <br /> t. -r ,2 f:K•. CICENSED FROFESSIQNAL.INFORMATION 3.5 . ' , . ,h,� U <br /> Business Name License Address Phone <br /> SEE PROPERTY OWNER INFORMATION Owner OWNER <br /> (Property) <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 450.00 GPD $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:04/12/2022 i std_BuildingApplication_pr <br />