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MARION COUNTY <br /> BUILDING INSPECTION <br />Senator Building ,, 220 High Street NE · Second Floor * Salem. Oregon 97301-3670 <br />Office Hours: 8:00- 4:30 Phone; 588-5147 24 Hour Code-A-Phone: 588-7904 <br /> <br /> APPLICATION FOR EXKMPT STATUS <br /> (FROM TNE STRUCTUI~%L SPECIALTY CODE) <br /> FOR ~ AGKIC~ BUiLDiNG <br /> <br />Assessor D~partment? (You must provide a copy of your tax statement <br />showing the farm deferral.) Y~ N __ <br /> <br />Are you located within the Urban Growth Boundary? y ~ N ~ <br /> <br />Describe in detail tho use of an~/~r~com~odities stored in the proposed <br /> <br />Is the proposed structure located within a flood plain? Y __ N <br /> <br />Does the proposed structure have any of the following syatems? <br />Electrical ~W Plur0bing __ 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 __ <br /> <br />IS this structure used by the public at any time? Y <br />Explain: <br /> <br />9. This appllcation will not be considered complete without a site plan. <br /> See attached site plan requirements. <br /> <br /> 10. What is tha distanc, from the nr~Dosed structure to property lines <br /> and/or other st~Jctures? Front'A~0& Left Side / ~% <br /> Right Side ~ Rear '~,~ Other structures <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 />rela~ing to building construction. <br /> ([ " c <br /> <br />P~ON~ <br /> <br />Planning Division validation <br /> <br />COMMENTS= <br /> <br />NAME (Please print) <br />STREET ADDRESS <br /> <br />CITY STATE ZIP <br /> DATE~ <br /> <br />Building Division Validation Byt <br /> <br /> <br />