Laserfiche WebLink
, 8oz..)e...v)A . . . .. . . <br /> - (..ob -70.D ):: <br /> tx�'tl y° <br /> Manufactured Home Trip Permit Application - <br /> • i •Department of Consumer and Business •Services - <br /> f <br /> �` :,� �f< ajuilding Codes Division <br /> Ic35 I,doew ncr St. NW. Salem. Oregon • Phone: 503-378-4530 • Fax: 503-378-4101 - - - - <br /> Web: orccron.govibcd • Email: mhods.bed(a orcgon.gov - . <br /> This application must be submitted with a valid tax certification front the county in which the home is currently-located; <br /> ;tis well as the county the home is moving to. A valid tax ceruticatton is one that has been certified try the cnunty.an l: - <br /> -submittedbclort the expiration date provided by the county at the time ofcertilication, . . . .. <br /> F .: , . ' . APPLICANT INFORMATION �a <br /> ,I_�unL:Amber Homes L LC 1 <br /> i \ddress(including city.state,and 7.1P) 221 Main Street Suite 2039 Los Altos, CA 94023 1 <br /> 11 Phcmc 650-946-2917 — <br /> ;1 I nail:enn.wiliams@atriberhomes.us <br /> TRANSPORTER INFORMATION <br /> Natitc;Superior Home Transport LLC y, <br /> I <br /> :Address(including city,state,and ZIP):257 N 6th St Jefferson, OR 97352 �. <br /> -Phone:541-327-7805 office <br /> Email:ritahartzell@gmail.com I <br /> HOME INFORMATION • . <br /> Home ID number(ifkilo n): DMV X-plate number(if known): .. <br /> ,Manufacturer:Fleetwood Mode1:230BM14663B Ycar:2023 <br /> HUD label numbers:IDA 255062 .. <br /> Serial numbers:FLE230ID21-37121A . . . <br /> . ADDRESS INFORMATION <br /> Current location (including city, state.ZIP):2611 E Cornstock Ave, Nampa, ID 83687 County:canyon <br /> Manufactured home park name, if applicable: —___ <br /> .0 Oregon dealer lot Dealer name: <br /> Out-of-state dealer lot Dealer name and contact information:Fleetwood Homes, 208.505.8230 j <br /> `Placement location(including city, state,ZIP):4915 Swegle RD NE lot 54 _County:Marion <br /> Manufactured home park name, if applicable: Sunset Village <br /> ❑Oregon dealer lot Dealer name: <br /> Applicant signature: ,, � ''---- <br /> Amount: <br /> • Trip permit(per section) S5.00(70511-1195) S5j - <br /> TOTAL S c, OD <br /> Make check or money order payable to Department of Consumer and Business Services. If paying by credit card,applicant <br /> must si n credit card information box. Do not send cash.Secure fax: 503-947-2333 <br /> D V sa MasterCard ❑Discover Phone:(j�l} t I Det�artment use only <br /> . , $ 5 'L <br /> Cardholder signature Amount <br /> Name of cardholder as shown on credit card <br /> %% U Deb 5 '-)qe..) t.P5 / <br /> .Credit card number Expiration <br /> �D BS <br /> Ctr. ,„f ird <br /> 8m''nni knees <br /> 440-5225(10/17/COM) <br />