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• <br /> ' <br /> ~ ~����� C� v� � � � 0 ��l�� 1: . 3 �� <br /> : "^--- '~° \< ^^-°~�� `~*«� "~�� "`� � xx��� "�c�' � <br /> _ <br /> r ` <br /> Manufactured �^ =� 1" � Permit Application <br /> Y ~73u-l3~ <br /> 'D- <br /> nm*f Consumer nod Business Services <br /> uwm/' 1.535 Edgewater St.NW.Salem.Lt °Phone:5V3737A-453O^Fax:50.1-378-4101 <br /> Web:orngon.g*v1eJ~ tmdi|: mUvusoougoroAon.tov <br /> -I-his application must he uhrniUed with a valid tax vt:flit-K.4)1kmfrom.the county En which the home is eel-featlyh:teak-4i, <br /> os`olmthe county the home isn`oin3to.&valid t;xeeniticmi^nisvorthat h.:*i�hc^ouc�iGxdhythe uou � <br /> minty <br /> 1 submitted xcd6x� xthe uyicuiondate provided by the coomyuxthe time ofcuniOca000 _____ <br /> -- ---^~--- ----- ---- APPLICANT \ON ~__ __^____- i <br /> - <br />� ___- _-_'- ___-___��-_� <br /> Nomc:Amb* HoneoLL[ _____ __._ ___ _____ __- -_- __ ___� <br /> ---------- ------------� ZIP):201 � LosAltusCkA;U2^ <br /> Address(includingcity,state,oodn� <br /> TRANSPORTER INFORMATION i <br /> _ ..,_ ...... __ _.., — , i <br />, Add.ress(including city state,and ZIT): '126U2 l'ry Rd NE At;ora,OR 97032 <br /> Yhoue:541�JO-5191 __ ________ _ . ______ __- -__ '__ _ _____' � <br /> __-__ / <br /> CmxU:xhm ___ ______ <br /> HOME <br /> _ INFORMATION '_ <br /> !tome <br /> .^' number`°-. DNI V X.-Auk number ----_____-~ <br /> NI <br /> Serial noomors/11:2100u/9'/96-52 ~ADDRESS INFORMATION <br /> _' <br /> _~ ____ <br /> ._ u�cc/)ozu--- /d � ZK1�655Pmg�ss0Yay.Vvuodbum.OR97O7II Countyum <br /> ' --' -- '- — <br /> '—!--------- � <br /> -� vreg«��a�` lot_IDuu|ornarno-f/enrw <br /> ood . <br /> _ __ <br /> CI Out-of-state dealer lot 1 Dealer name and contact information. . <br /> i'lrieernent Ineation(Ineludnig city, state,ZIP):2016 Kennedy Circle NE SPC_#13,Keizer OR 01303 1 County:Clar...kamds <br /> i0 Oregon dealer kit•I Dealer name . -- ____. <br /> ss.,,,,,,,,,„,,,,..,,051._ S5,DO___ . <br /> L-- ; <br /> --____' -_-_ <br /> MAC.check vrmoney order runomumDevito molt vnomm"*r*munsi"i-s^Services.npaying»'credit card.,ynucort <br /> rOdi :53-9i47-2;o3 _ <br /> _mit sign <br /> L]V/,.i L]wav*C^m hm*pyt/ r^w0;1_ L -_- / Department use only <br />� ____ _ $ <br /> zvu mroluzil <br /> ��nmcrim*mn�°u.V..'`TC'a-C;(1.1 <br /> / <br /> --- ------- --------- -����[�-- -k <br /> u*m u ___�_ ___ _� <br /> --- ----- <br /> . <br /> fit DCBS <br /> +x es(mnno.wV <br /> — ____� _-__-_ ____ ____- ___ - ____ -_~�__- <br />