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<br /> Manufactured Home Trip Perliiitl- Apl)lielitiogi (00'7 0 i
<br /> Department of Consumer uid Business Seri.ices
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<br /> •,---, ', . Iluilding Codes Division
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<br /> 1535 laigek‘aiet Si N1V. S.dcm. ()rept) • Phone 503.17;.;-1 ";(1 • kr.. '111-17X-1101
<br /> • Web: htegim.gov.'hcd . l'Illall: Illittlii .biAlle/Ilk:11014o; . .
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<br /> Fiii.%applieittion nith,t be stIhtlillted \\1111 a, valid lax cell i new ion nom the Cutlftly 111 \t 11.101E11i tom 1:, cunit!‘ Ifik.-mol.
<br /> as'ts.ell•a's the counts,the Imine is Intm mg to. A valid lax certification is one dial has he'en cefillied hi. d :L!iiiiiiv;iiiii
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<br /> .111hMittedbet lifc the L'XI'lli anon uau.'pro',idid by thu county tit the 11111c (11 ectfIlic,i1itin . .
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<br /> APPLICANT INFORMATION •.. . ,
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<br /> i....*,,Itty. Amber Homes f_Le... . .
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<br /> . Addres.,7 1.1I11:1.0011.1,12,C.11t, sLilt:. ;ntil /W1.221 Main Street. Sitifit 20:3(..) Los Alit' CA TICV3 •
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<br /> P )11c-6S I O-946-2917 ..
<br /> • . , 1 y. ,,- • • • • - - . _... ........ _ . ...______.
<br /> I t-tfnailtenti,wiliarris@amberhpmes_us . . . • ..
<br /> . • - - - TRANSPORTER INFORMATION
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<br /> • . .' Nartic:S000idullaiii6--TranspiSrt LLG
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<br /> ' . • -tt 1Licc:ss•iiiwItiiillit4cir.v:io:.ttc, :Anil 7.1P1:257 N-6th Si Jeffersbn. OR 97352
<br /> , . f lit.rici 541-32r-7,-805 office .
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<br /> . I lirmiillritehaiLteliggrilaIl.com • . • .
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<br /> • . - - HOMEINFORMATION
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<br /> Hon-lc tr.i'raimi)&(if kuoirn): I DMV X-phitc ntiniber 0//./1/./11*/)1:
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<br /> NiailiilitcturcitF leetwOcid- - • ' - • lel 230BM14663E3
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<br /> t:Hur)lbe i at•iiiititici'sADA,255062': ' , ' - ' • •. -
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<br /> Cilfl'iliplicr.:::.iF1.: 2301D21737121),N . :,:.i:: - - .... •
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<br /> ADDRESS INFORMATION . .
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<br /> . • Ctiri-ctil 1( -ilL.ii:Jri,(,inCitidilig.Ci(;.st:itc.7IP•) 611 ECornstoek Ave. Nampa, ID 83687 i
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<br /> liinty•canyon
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<br /> Nbriii.l'aClu'i6.1ht411C titirk:narile. icapplicabkt .
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<br /> 1- -Ore)...611-.dCLILCi-14 ' Dealer .. .
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<br /> • ,, A-Out-olltatc dcz.11cr itit 1 Pt:tiler iianic.:.irid Co'nfnet inlotinttliolv FleeNvoott HorneS. 208 505 8230
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<br /> 1.11zi•L'effIclif 16.-(alion(including cit,..,state; ;.'.•11'4,-,•4915 Swegle RD NE lot 54 1 ( ount‘:yarion_ ...,..
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<br /> • :i NI4notaoni-ed.hcnnc,pork.name,-. ilapillie;1111c; Sunset Village -
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<br /> - i 0 Out lot . Dolername: . ' :i . •
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<br /> • „.1pplwarn sipature:. . ..y.-.: /.. s_..------:-: . - _ — ____
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<br /> - ; Amount:
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<br /> ' Trip permit (per- •
<br /> ionl $5.00(70511-1195)
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<br /> :Make check or Ilinney 'order payiihle to Dep,artntent of Consumer and Business Services. If pay in h) credit card.applicant
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<br /> .. i must sign credit cariVinfOrrnntion box.Do not send cash.Serum fax: 51B-9'47-2333
<br /> . , El V•ca tz-Ntec. ri -0•Discover phone (3(A ) . '
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<br /> . Cardholder s igna tore . , Ainount
<br /> Ual 11"1‘ '
<br /> 6=405- '
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<br /> Name oIcardholder as shown on credit card .
<br /> '• 5560 0 clbb c,7)t-18 ill 5 a ____LELLIZA
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<br /> • 'Credit card.,nurnber Expiration ,.. ... .. _
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<br /> -5225 flOif WOW •
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