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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 I~R EXm. MPT STATUS <br /> (FROM THE STRUCTURAL SPECIALTY CODE) <br /> FOR AN AGRICULTURAL BUILDINO <br /> <br /> __ msa'rp: __ oE: __ ACRES, 6,OK <br />SECTION= <br /> <br /> by the Marion County <br /> of your tax statement <br /> <br />Is this property classified as far~eT~;~al <br />Assessor Department? (You must prepays a <br />showing the farm d.f.rral.) y /~ ~ <br />Are you located within the Urban Gr~w~ndary? <br /> <br />Describe in detai~ th~ ute o~ and//~r commodities 9_[ored 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 systems? <br />Electrical ~ Plur~bing __ ~eating/cooling/Ventilation <br />Where will restroom facilities be provided? ...... ~/~ <br />Will persons be working in the structure more than/a total of 144 hours, <br />during any week of th~ year? Y __ N <br /> <br />Is this structure used by the public at any time? Y <br />Explain= <br /> <br />This application will not be considered complete without a site plan. <br />See attached site plan requirements. <br /> <br />10. <br /> <br />What is the distance from the proposed structure to p~perty lines <br />and/or other structures? Front ~ ~ Left Side ~ <br />Right Side ~0 ~ Rear ~9--t~~ ' Oth~r 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 />relating to building construction. <br /> <br />SIGNATUP~E <br />DATE <br /> <br />PHON~ <br /> <br />OFFi~ ~ olq~y sITUs NO. <br /> <br />Planning Division Validation By: <br /> <br />Building Division validation By: <br /> <br />NAME (Please print) <br />STREET ADDRESS <br /> <br /> CITY STATE ZIP <br /> <br /> 3-p, ...... " <br />'"ZONE: MAP: <br /> <br /> DATE: <br /> <br /> <br />