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o MARION COUNTY <br /> BUILDING INSPECTION <br /> C°mmunity Devel°pment Center ° 285 Church St' NE ' R°°m 132 ' Salem' Oreg°n 97301 <br /> Office Hours: 8:00 - 4:30 Phone: 588-5147 24 Hour Code-A-Phone: 588-7904 <br /> <br />(You must provide a computer printout verifying ,specia <br />This can be obtained at the Marion County Assessor s Office located in the Franklin <br />Building, 495 State Street, Salem) <br /> <br />Are you located within the Urban Growth Boundary? Y __ N <br /> <br />Describe in detail y, our commercial fa. rm ent. erprise: 32 <br /> <br /> j- <br /> <br />Describe in detail the use of and/or commodities stored in the proposed structure: <br /> <br /> ,/ <br /> <br />5o <br /> <br />9e <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 A/~N Plumbing Y N ~ 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, 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 proposed structure to property lines and/or other <br />structures? Front Rear <br /> Left Side Right Side Other structures <br /> <br />11. <br /> <br />This application will not be considered complete without a site 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 state laws and county ordinances relating to building <br /> <br />construction. <br /> <br /> SIGNATURE <br /> DATE <br /> PHONE <br /> <br />NAME (Please print) <br /> <br />~TREET ADDRESS <br /> <br />c~ ' s~z~v <br /> <br />OFFICE USE ONLY <br />PLANNINO DIVISION: <br /> Validated By: <br /> <br />COMMENTS: <br /> <br />SITUS NO. ZONE: ~.~'~ MAP: <br /> <br />BUILDING DIVISION: <br /> Validated By: <br /> <br />COMMENTS: <br /> <br />Approved: Denied: Date: <br /> <br />APPROVED: DENIED: STRUCTURAL PERMIT IS REQUIRED <br /> Other permits required: Electrical, Plumbing, Mechanical, Septic <br /> <br />MC 15-76 <br />REV 8/94 <br /> <br /> <br />