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BUILDING <br /> Senator Building * 220 High Street NE * Second Floor - Salem, Oregon <br /> <br /> t -, <br /> FROM THE STRUC~ SPECI=,Y COD~ <br /> BUILDING INOPECTIO <br /> <br />1, I~ thi~ property ela~sifled a~ Earm d~ferred? Y ~ N <br /> (You must provide a computer p~in~out verifyin~pe'~al assessment fo~ farm <br /> This can be obtained at the Marion C~unty Assessor's Office located in the Franklin <br /> Building, 495 state Street, salem) <br /> <br />2. Are you located within the Urban ~owth Boundary? Y N <br /> <br />3. Describe in ~etail yo~ co~ercial far~ enterprise: ~ ~ ~.~.~ <br /> <br />4. Describe in detail the use of i,,d/oz car=~the ~op~?~ )~ucture: <br /> <br />5. Is the proposed structure located within a flood plain? Y __ N <br /> Electrical Y ~ N__ Plumbing Y / N__ Nearing/Cooling/ventilation ¥ ~ N <br /> <br /> a. will persons be working in the structure more than a total of 144 hoursr durin9 any <br /> week of the year? Y __ N <br /> <br />9. Is this structure used by the public at any time? Y N ~ <br /> <br /> 10, What is the distance from the proposed structure to property lines and/or other <br /> <br /> Left Side ~1 Hi~ht~p' Other structures <br /> <br />~. ~his appli~atlo~ will not he considered complete without a site plan, See attached <br /> site plan requirements. <br /> <br />I certify ~hat I~have re~d this appli~atio~ a~d state that the £n~o~mation ~i~n <br /> bui~din9 <br /> <br /> S~GNATUHE -~/ ~----~ N~ {Please~(~/~print) <br /> STREET ADD,SS <br /> <br />PHONE CITY STATE~Z'~P <br />P~ING DIVISION: ' <br /> <br /> BUILDING DIVISION: <br /> <br />APPROVED: / ~ DENIED l ~N ~~- ~ <br />REV 9/93 <br /> <br /> <br />