Laserfiche WebLink
/40 ':.*-)* Manufactured Home Trip Permit Application <br /> .:' -'u z, 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 /> APPLICANT INFORMATION' , <br /> Name: Lorrie Morlan <br /> Address (including city, state, and ZIP): 4396 Waconda Rd NE <br /> Phone: Salem OR 97303 <br /> Email: amorlanll@msn.com <br /> TRANSPORTER INFORMATION <br /> Name: Doug's Mobile Home Service <br /> Address (including city, state, and ZIP): 12692 Fry Road NE, Aurora, OR 97002 <br /> Phone: 503-799-0539 <br /> Email: dugwalton@aol.com <br /> HOME INFORMATION <br /> Home ID number(if known): 257530 DMV X-plate number (if known): <br /> Manufacturer: Silver Crest Model: Year: 1989 <br /> HUD label numbers: <br /> Serial numbers: AC7SC54070R, BC7SC5407OR <br /> .ADDRESS INFORMATION <br /> Current location(including city, state,ZIP): 1422 Matheny Road NE, Gervais, OR 97026 County: Marion <br /> Manufactured home park name, if applicable: <br /> El Oregon dealer lot Dealer name: <br /> ❑Out-of-state dealer lot Dealer name and contact information: <br /> Placement location(including city, state,ZIP): 4396 Waconda Road NE, Salem, OR 97303 County: Marion <br /> Manufactured home park name, if applicable: <br /> ❑ Oregon dealer lot Dealer name: <br /> Applicant signature: 494)-ut <br /> (( Amount <br /> 41111CoR MS <br /> pc( of <br /> A--0 <br /> 430co wCiccncq <br /> 9 <br />