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Lana./5 1-eti Us <br /> SfL1314 6o0 °zIA?) -1 <br /> Manufactured Home Trip. Permit Application <br /> Department of Consumer and I3usinessServices <br /> tra, Büilding'Codes Division <br /> 1535 Edgewater St.,NW,Salem,Oregon•Phone: 503-378-4530•Fax:503-378-4101 <br /> Web: oregon.goV/bc'd •&nail:inhOds.bcd@Oregon,goV <br /> Thisapplication must besubmitted with a valid.tax certification from the county in which the.homeis currently located, <br /> as well as the county.thehome is moving to.A valid tax certification is one that has been certified by the county and <br /> SubMitted befcre the expiration date preVided by the county at the time of certitication. <br /> Name:CPI-SUNDIAL TRs LLC <br /> Address(including city,iitate,and ZIP):4615 25TH.AVE NE#701, SEATTLE-EWA 98105 <br /> Phone:503-363-6234 <br /> Email:SUNDIAL@FCPNW.COM <br /> Name:ROGERS HEAVY:HAUL LLC <br /> Address(including city, tate, and ZIP):12121 HILLCREST DR SE,YELM,WA 98587 <br /> Phone:360-507-7015 1: <br /> Email:YELMHAULING@GMAIL.COM <br /> - HOME lNFORMAflON .. <br /> Home ID inirnber(fknolrit): kJ <br /> E\IV DMV Xplate number.(ifknown): <br /> Manufacturer:MARLETTE Model:55CRC28483CH21 Year:2021 <br /> HUD label numb&S:NTA1988881 /NTA1988882 <br /> Serial nurnbers:HER032536ORA/B <br /> Current location(including city,state,ZIP):400,W ELM AVE, HERMISTON,OR 97838: County:Urcatilla <br /> Manufactured home parkiname,.if applicable: <br /> IN Oregon dealer lot Dealer name:MARLETTE HOMES (Factory-new borne) <br /> 12 Out-of-state dealer lot Dealer name and contact <br /> Placeinent iodation(inet4ding city,State,ZIP):2200 LANCASTER DR.SE,#.13A,Saleit,-OR 97317 conntyMaticin <br /> Manufactured.home:parnanie, if applicable:Sundial Mobile Home Park <br /> ID Oregon dealer lot D.ealer narhe: <br /> Applicant:Signature: 1/4. ,Tara RiviniusiAgent for Owner <br /> N4,0;11 Nei . .,• , • <br /> ni;*4 <br /> Trip permit(per section) $5.00(70511-1195) -$10.00 <br /> $10.00 <br /> Make check Or money order payable to Department of Consumer and BasinesSSehrites:If-paying by eretliteard,,applicant <br /> must sign credit card infr;-rmation box.Do notsend cash.Secure fax:-503-947=2333 <br /> • E — • Phone:003)363-6234. Department vPse:cin 1Y <br /> gliD• / <br /> $10.00 <br /> 11/4111000" 11P. :; <br /> 30r ardho erstgnature Aniount <br /> CPI S DIAL oWNER 1..4c <br /> Name of cardholder as shourii on credit card <br /> Credit card number Expiration <br /> OID( CBS: <br /> .7; <br /> 'Consumer and <br /> Builness ServIcei <br /> 440-5225(10/17/o0M) <br />