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MARION COUNTY <br /> BUILDING INSPECTION <br /> <br /> APPLIC.~ION FOR EXI~IPT STATUS <br /> FROM TH~ STRUC~ SPEC~Y ~DE <br /> <br />~, IS this property classified as farm deferred? Y ~ ~ N ~~~~arm us <br /> (Xou must provide a computer printout verlfyin~ 9pecial asses e~ <br /> ·his ~an be obtained at the Marion County Assessor's Office located in the Franklin <br /> Building, 49~ Stat~ Street, Salem) <br /> <br /> ~q~,~ ....... <br />4. Describe in detail tho uso of and/or Co oditi~ stored in the proposed ~tructure: <br /> <br />5. Is the proposed structure locate~ within a flood plain? Y N <br /> <br />6. Does the proposed structure have any of th~following systems? <br /> ~lectrical Y ~ N Plumbing X '~ N_j~_ Heating/Cooling/Ventilation Y__ N <br /> <br />7, Where wall restroom facilities be provided? ~.~ <br /> <br />8, Will persons be working in the st~u:cture more than a total of 144 hours, during amy <br /> week of the year? Y N <br /> / <br />9. Is this structure used by the publig at any time? Y__ N <br /> Explain: <br /> <br />10. What is the distance from the prQposed structure to property lines and/or other <br /> ~tructure~? Front 3' <br /> Left Side ~,,~ iRight Sid~ ~OO~ Other structures <br /> <br />11. This application will not he considered complete without a site ~lan. 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 buildlng <br />construction, <br /> <br /> DATE <br /> <br />P~%}~IMO DIVISION: <br /> validated By:j~ Approved: / Deniedl <br /> <br />NA~CE (Please print) <br /> <br />~T~ET ADDRESS <br /> <br />BUXLDING DIVISION: <br /> Validated By= <br />COM3~TS: 3~54_. ~ <br /> <br />Approved= <br /> <br />Denied: <br /> <br /> u 'J <br />APPROVED: ~ DENIED= STRUC~J~2%L PERMIT IS ~QUI~D <br /> Other permits required:~ PlYing, Mechanical, Septic <br />MC 15-76 <br />REV 8/94 <br /> <br /> <br />