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BG50 E-42.e_t 5-1-y-un <br /> (04 <br /> .e.,-;:7 A Manufactured Home Trip Permit Application <br /> ' 1." J-% Department of Consumer and Business Services <br /> Building Codes Division <br /> c-r. . 1535 Edgewater St,NW, Salem,Oregon•Phone: 503-378-4530 •Fax: 503-378-4101 <br /> Web: oregon.gov/bcd•Email:mhods.bcd@oregon.gov <br /> This application must be submitted with a valid tax certification from the county in which the home is currently located, <br /> as well as the county the home is moving to.A valid tax certification is one that has been certified by the county and <br /> submitted before the expiration date provided by the county at the time of certification. <br /> .:..... .....�..,... ................. ..............:..............u:,_.: .. P•P•L C� NT� NFORM T: <br /> Name:Factory Homes Clearance Center Inc <br /> Address(including city,state,and ZIP):18150 SW Boones Ferry Rd Portland, OR 97224 <br /> Phone:971-224-2244 <br /> Email:janetm@gunnerllc.com <br /> .:••:.:.......:..,:....>..:.:::....::..:..... . .. ......:,:...:•.:.........7'RAf�S..P.:.ORTER:INF:ORMATION:::..:;.:::.::.:::....:...:.............:..:.:..::�:::::::::::;.:::: :::•::,:��:::;::::: :�:;° : <br /> Name:Phil Sterling <br /> Address(including city,state,and ZIP):17230 Beck Rd Dallas, OR 97338 <br /> Phone:503-932-2629 <br /> Email:philsterliIng1@gmail.com <br /> : .... ..:.......... ..... .. .. :H ... <br /> :`. ::` .;:��°:::.•::..:::.:..:... ....:.:.<.....:......:.:.....:............: . :...,.:... <br /> Home ID number(if Laron): • DMV X-plate number(if known): <br /> Manufacturer:Skyline _ Model:West Ridge • Year:2021 <br /> HUD label numbers:ORE 554 927 ORE 554 928 ORE 554 929 <br /> Serial numbers:245-000-H-A100727AB C <br /> ::ADD <br /> Current location(including city,state,ZIP):550 Booth Bend Rd McMinnville OR 97128 County:Yamhill <br /> Manufactured home park name,if applicable: <br /> ❑Oregon dealer lot Dealer name: <br /> 0 Out-of-state dealer lot Dealer name and contact information: <br /> Placement location(including city,state,ZIP):8050 Etzel Rd SE Stayton,OR 97383 County:Marion <br /> Manufactured home park name,if applicable: <br /> ❑Oregon dealer Iot ealer name: <br /> Applicant signature: -••-EM, Z <br /> Amount:'"`.... <br /> Trip permit(per section) $5.00(70511-1195) $15.00 <br /> $15.00Make check or money order payable to Department of Consumer and Business Services.If paying by credit card,applicant <br /> must si!u credit card information box.Do not send cash.Secure fax: 503-947-2333 <br /> El a 0 MasterCard ❑Discover hone:071)224-2244 Department use only <br /> $15.00 <br /> II Cardholder signature Amount <br /> Facto, Homes Clearance Center Inc <br /> )23 <br /> on <br />