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Kotc_- inc Ln S , Sculon: <br /> Manufactured Home Trip Permit Application <br /> , glitv,1 <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:.orgon.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 /> • APPLICANTINFORMATION : • <br /> Name:FUTURE HOMES OF ALBANY LLC <br /> Address(including city,state,and ZIP):33964 OAKVILLE RD SW,ALBANY OR, 97321 <br /> Phone:360-900-6982 <br /> Email:TITLING@FlJTUREHON1ESANIERICA.COM <br /> TRANSPORTER INFORMATION <br /> Naine:PHIL STERLING,HOME SERVICE INC <br /> Address(including city.'state,and ZIP):17225 BECK RD, DALLAS,OR <br /> Phone:503-932-2629 <br /> Email:PHILSTERLING1©QMAIL.COM <br /> ' • . • HOME INFORMATION <br /> Home ID number(if known): DMV X-plate number(if known) <br /> Manufacturer:FLETWOOD HMOES Model:210EG28523P . Year 2023 <br /> HUD label numbers:ORE 561277&ORE 561278 <br /> Serial numbers:FLE2100R23-23229AB <br /> ADDRESS INFORMATION • . , <br /> Current location(including city,state,ZIP):33964 OAKVILLE RD SW,ALBANY OR, 97321 County:LINN <br /> Manufacturedhome park name, if applicable: <br /> CI Oregon dealer lot Dealer name:FUTURE HOMES OF ALBANY LLC <br /> 0 Out-of-state dealer lot. Dealer name and contact information: <br /> Placement location(including city,state,ZIP):4987 RaCin-e LrI S , Salem, OR 97302 County.MARION <br /> Manufactured home park name, if applicable: <br /> 0 Oregon dealer lot. Dealer name: <br /> , Applicant signature: <br /> -- <br /> Amount <br /> Trip permit(per section) $5.00(70511-1195) $ <br /> .-TOTAL $ <br /> Make check or money order payable to Department of Consumer and Business Services.If paying by credit card,applicant <br /> must sign credit cardinformation box.Do not send cash.Secure fax: 503-947-2333 <br /> 0 Visa El MasterCard laDiscover Phone:( .) <br /> Department use only <br /> • Cardholder signature Amount <br /> Name of cardholder as shown on credit card <br /> Credit card number Expiration <br /> tft CBS <br /> Console'VI <br /> Busznesi Services <br /> 440-5225(10/17/COM) <br />