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MARION COLrNTY <br /> BUILDING INSPECTION <br /> Senator Building * 220 High Surer NE · Second Floor * S~len~ O~gon 97301-3670 <br /> Offi¢~ Hours', 8200- 4:30 Phone: 588-5147 24 Hour Cod~A-phone: 588-7~ <br /> <br /> ~LI~ATION FOR gX~T <br /> ~OM THE STRUC~ SPECI~TY COD~ <br /> FOR ~ A~RI~ BUILDING ON A CO~RCI~ <br /> <br />Is this prope=ty classified as farm deferred? Y N ' / <br />(You must provide a computer printout verifying special assessment for farm use. <br />Thi~ ean be obtained g~ ~he Marion County A~osgo~g Offic~ lo~ated i~ tho Franklin <br />Building, 495 State Street, Salem) <br /> <br />Are you located within the Urban Growth Boundary? y __ N <br /> <br />Describe in d~tail your co~er¢ial farm onterprlse: <br /> <br />IS the proposed structure located within a flood plain? Y __ N ~----~' <br /> <br />Does the proposed structure have any of the following systems? <br />Electrical Y ~- N Plumbing Y H.F'----~Heating/Coollng/ventilation Y <br /> <br />where will restroom facilities be provided? <br /> <br />Will persons be working in the structure more than a total of 144 hours, during any <br />week of the year? Y N <br /> <br />Is this structure used by the public at any time? Y N~ <br />Explain: <br /> <br />10. <br /> <br />What is the distance from the proDOsed~c~ure to property lines and/or other <br />structures? Front <br /> Left Sih~-/~ Right Side~__ Other structures/__~O__/_ <br /> <br />11, Thi~ application will nob be considered complete without a ~ite plan. See attached <br /> site plan requirements. ' ~ ...... <br /> <br />I certify that I have read this application and state that the information given is <br />correct, i agree to comply with all~stateilaws end county ordinances relating to building <br /> <br /> TE -- ' <br /> <br />OFFICE USE ONLY SITUS NO. <br />PLANNINO DIVISION: <br /> Validated By~ __ Approved: <br /> <br />COMMENTS: <br /> <br />ZONI~: <br /> <br />Denied: Date: <br /> <br /> BUILDING DIVISION: <br /> Validated By: ~ Approved ~ Denied: ~'/' Date: <br /> <br />APPROVED: __ DENIED g ~~_~ STRUq~j_~-~QU I ~D Other pemits rsqui~-Electrieal~ Pl~in~ ..ehanical, S)ptic <br />MC 15-76 ~ / ............... <br />~EV 9/93 <br /> <br /> <br />