Laserfiche WebLink
f <br /> 488 <br /> a t,anc.g,s4--ex Ci . o g, 3 C0• <br /> 04. Manufactured Home Trip Permit Application <br /> `�� Department of Consumer and Business Services <br /> " 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 /> . ` 4;4 ' ' AP L;IGANT,3,INFORMATI N k5. <br /> Name:COMMONWEALTH HOMEOWNER SERVICES <br /> Address(including city,state, and ZIP):18150 SW BOONES FERRY ROAD, PORTLAND, OR 97224 <br /> Phone:503-244-2300 <br /> Email:melisa.cook@cwres.com <br /> 4;47., 1 "', , , :TRANSPORTER'INFORMATION,. r <br /> _.. �.� +.°F < *. ., .<..awn'�'r+�+.,., <br /> Name:BENNETT TRUCK TRANSPORT, LLC <br /> Address(including city,state, and ZIP):1360 INDUSTRIAL WAY, WOODBURN, OR 97071 <br /> Phone:503-981-7939 <br /> Email:nancys.wbo@bennettig.com <br /> 6 : g N .;.HOME INFORMATION . ., ` ' <br /> Home ID number(if known): DMV X-plate number(if known): <br /> Manufacturer:FLEETWOOD Model:SANDPOINTE Year:2023 <br /> HUD label numbers:ORE 561301 <br /> Serial numbers:FLE210OR23-23247A <br /> to „ ; . >° . <br /> ADDRESS INFORMATION <br /> Current location(including city,state,ZIP):1360 Industrial Way, Woodburn, OR 97071 County:Marion <br /> Manufactured home park name,if applicable: <br /> ❑Oregon dealer lot Dealer name: <br /> ❑Out-of-state dealer lot Dealer name and contact information: <br /> Placement location(including city, state,ZIP):4882 Lancaster Drive NE, Sp.#36,Salem, OR 97305 County:Marion <br /> Manufactured home park name,if applicable:Starlite MHC <br /> ❑Oregon dealer lot Dealer name: <br /> Applicant signature: c --..c3t�.. "a,I <br /> Amount: <br /> Trip permit(per section) $5.00(70511-1195) $ <br /> :,. k '...,i.' ; ,. .i;TOTAtz,V $ <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 El Discover Phone:( ) <br /> Department use only <br /> $ <br /> Cardholder signature Amount <br /> Name of cardholder as shown on credit card <br /> Credit card number Expiration <br /> t �, BS <br /> • Commend <br /> 440-5225(10/17/COM) , <br />