Laserfiche WebLink
.35 60 brôcn Rot b ScL J.o_rr► x730.5 <br /> 4 Cob. --i <br /> 4 .N.,v.4. Manufactured Home Trip Permit Application <br /> A1'r� o•; Department of Consumer and Business Services <br /> ''''°��'payz� Building Codes Division <br /> 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 /> APPLICANT INFORMATION._. : : <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 /> : `TRA NS PORTER.:.INFORMATION . <br /> .:,°' <br /> Name:Doug's MH Setup and Transport <br /> Address(including city,state, and ZIP):12692 Fry Rd NE Aurora, OR 97002 <br /> Phone:503-799-0539 <br /> Email:dugwalton@aol.com <br /> .:' FRMATI N`::..HOME IN .:O O .: ..`. . .... ... . . .. ... .. <br /> Home ID number(if known): DMV X-plate number(if known): <br /> Manufacturer:Fleetwood . Model:Eagle Year:2021 <br /> HUD label numbers:ORE 555194 ORE 555 195 <br /> Serialnumbers:FLE210OR21-21454A FLE210OR21-21454B <br /> . : .:ADDRESS'INFORMATION ... <br /> MA N <br /> Current location(including city,state, Z1P):4735 Turner Rd NE.'Salem, OR 97317 County:Marion <br /> Manufactured home park name, if applicable: Se <br /> ❑Oregon dealer lot Dealer name: <br /> ❑Out-of-state dealer lot Dealer name and contact information: <br /> Placement location(including city,state,ZIP):2560 Brown Rd NE Salem, OR 97305 County:Marion <br /> Manufactured home park name,if applicable: <br /> ❑ Oregon dealer lot De tiliii ame: • <br /> Applicant signature: , 1) t <br /> :Am.ount :.:,.. <br /> Trip permit(per section) $5.00(70511-1195) $10.00 <br /> A $10.00 <br /> Make check or money order payable to Department of Consumer and Business Services.If paying by credit card,applicant <br /> must sign credit card information box.Do not send cash.Secure fax: 503-947-2333 <br /> ❑Visa ❑MasterCard ❑Discover Phone:( ) Department use only . <br /> $ <br /> Cardholder signature Amount <br /> Name of cardholder as shown on credit card <br /> Credit card number Expiration • <br /> Ii1iJCBS <br /> Consumer and <br /> Business Services <br /> 440-5225(10/17/COM) • <br />