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MARION COUNTY <br /> BUILDING INSPECTION <br />Senator Building · 220 High Stree: NE * Second Floor · Salem, Oregon 97301-3670 <br /> <br /> Office Hours: 8:00- 4:30 Phonc; 588-5147 24 Hour Code-A-Phone: 588-7904 <br /> <br /> APPLICATioN FOR EXI~PT STATUE <br /> (FROM ~n~ STRUCTURAL SPECIALTY COD~) <br /> <br />Is this property classified as farm deferral by the Marion County <br />Assessor Department? (You mu~t provide a copy of your tax <br />~howing tho farm deferral.) Y / <br /> <br />Are you located within the Urban Growth Boundary? Y N <br /> <br />Describe in detail the use of and/or co~odities stored in the proposed <br /> <br />Is the proposed structure located within a flood plain? ¥ N <br /> <br />Does the proposed structure have any of the following systems? <br />Electrical ~ Plumbing .~ Heating/Cooling/Ventilation <br /> <br />Where will restroom facilities be provided? /~ <br /> <br />Will persons be working in the structure more than a total of 144 hours, <br />during any week of the year? Y __ N ~ <br /> <br />Is this structure used by the public at any time? Y N <br />Explain: <br /> <br />9. This application will cot be considered complete without a site plan. <br /> see attached site plan requirements. <br /> <br /> 10. What is the distance from the proposed structure to property lines <br /> and/or other structures? Front ~-.( Left Side ~ <br /> <br />I certify that I have read this application and state that the information <br />given is correct. I agree to comply with all state laws and county ordinances <br /> <br />C~;~ing to building construction. S I G/NATRSRE~ . <br /> <br /> PHONE <br /> <br />OFFICE USE ONLY <br /> <br />Planning Division Validation By: <br /> <br />N E (~1 int " ~.~ <br />ST~REET ~DRES~ <br /> <br />CITY STATE ZIP <br /> <br />DATE: <br /> <br />COMMENTS: <br /> <br />Building Division Validation By: ~,~~.~ DATE: <br />COMMENTS~ <br /> <br /> <br />