HomeMy WebLinkAboutApplication APPLICANT 7/10/2020City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
SPRINGFIELD
(City Staff completes form)
Permit Type
Dept of Motor Vehicles -New: ❑
Land Use Compatibility Statement: ❑ City:.p
Dept of Motor Vehicles -Renewal: ° Zoning Verification Letter: ❑ UGB: ❑
Project Information
Applicant Name:V^ CVI, buto, Phone•
Company: mldNm
trl,L[
Cell:
Address: l
5�� l�,- ey (%
Property Owner:
1ric-.
Phone:
Company:
Cell:
Address: LtIMP YY\A l,v1 5,TY-e1'
-
ASSESSOR'S MAP NO: j� DZ'J�3Z
TAX LOT NOS : O
Property Address:
Description of Proposal:
We Sala lot-
J
:Recordukd
rmation
p.
Record No: p�I"a8' 170�A— PI
Date Received: t�t f j 0 2{j
Application Fee: $ 3
Technical Fee: $ J I. is
__3L}
TOTAL FEES: $ 3 Lo O.6
Assigned Planner:
Revised 11.2.11 kl
10
11
APPLICATION FOR
THREE YEAR VEHICLE DEALER CERTIFICATE
AS A DEALER ORREBUILDER OF VEHICLES
."
CUSTOMER NUMBER
EFFECTIVE DATE
EXPIRATION DATE
DEALER NUMBER❑ORIGINAL
LO]RENEWAL
If this is a renewal, do not complete the fee information. Use the attached
>
CERTIFICATE FEE
billing list to calculate your fees. The billing list MUST be submitted with your
renewal application.
LATE FEE
Original Certificate (Includes one plate)................................. $1,187.00
SUPPLEMENTAL$
Additional Locations @$350.00— .......... ....... $
RENEWAL PLATES
(Supplemental Application Form 735-372 required for each location) o as
I 5
ADDmoNaL PLATES
plates 12" x 6--j1— or 7" x 4"@$54.00... $
(Two sizes, standard and small, available)
TOTAL $
TOTAL = $12gc
>
TEMPORARY PLATES
BUSINESS NAME AND ADDRESS An alleration of Line 3 voids location approval.
LEGAL NAME OF APPUCANT(OWNER, PARTNERSHIP, UC OR CORPOUA11M NAME)
FEDERAL IO NUMBER (FEIN) OREGONREGISTRY#pFLLCORDORPORATON)
131-3
L Clarza
Z 16401 11ts 3lag4b
BUSINESS NAME(IF ASSUMED BUSINESS NAME, FILL IN REGISTRY NOJ
OREGON REGISTRY NO.
BUSINESS TELEPHONE
1Zo al i (� M LL
I(a37)990
;LII SIN 8115
MAIN SINE 1-0CATION (STREETAND NUMBER)
CITY
ZIP GOD E
COUNTY
10(9 fvLa;n s
S ti
SII
MAILING ADDRESS
, f
CI
�i
1 01'G
STATE ZIP COLE
or
MAIL
EMAIL I1eYn,q}rvca qi
I 9
LIC)b soA st S rim
L�
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TYPE OF OPERATION j
I If apcx,asttheeteheunder
CHECK ORGANIZATION TYPE:
which busineaa 6 incoryorated
❑Intlivitlual ❑Pertnershlp LYLLC ❑COrpOretiOn:
1 /we primarily sell: ❑ New Vehicles Used V�ehicles
1 / we are a franchise dealer: ❑ Yes FT No If "Yes," name the makes >
I / we sell NEW RECREATIONAL VEHICLES: ❑
Yes RT No
IF "YES," SERVICE FACILRY LOCATION (STREET AND NUMBER)
GTTY
ZIP CODE
LOCATION APPROVAL (If renewal, required only if dealer Is changing business location)
Certification of local zoning. ORS 822.005 requires a vehicle dealer certificate, unless exempt under ORS 822.015, for any person
who:
(a) Buys, sells, brokers, trades or exchanges vehicles either outright or by means of any conditional sale, bailment, lease,
security interest, consignment or otherwise; OR
(b) Displays a new Or used vehicle, trailer, or semitrailer for sale; OR
(c) Acts as any type of agent for the owner of a vehicle to sell the vehicle or acts as any type of agent for a person interested in
buying a vehicle to buy a vehicle.
THE CERTIFICATION BELOW IS TO BE COMPLETED BY THE LOCAL ZONING OFFICIAL. The approval below should be based
upon whether the applicant can do ANY of the activities listed in (a) through (c) above under applicable ordinances, at the location
of the business given on Line 3. Pursuant to ORS 822.025, applicant shall meet requirements below.
As the zoning official for the judsdiction where this business is located, i verify by my signature that the location of this business as stated on this application
complies with any land use ordinances of the jurisdiction pursuant to ORS 822.015.
`
CITY OF: oA ,,k) ❑ COUNTY OF:
TELEPHONE NUMBER
(51A1 )-7AJ002
PRINT NAME
0.1
TITLE
PlaAnu
SIGNATOR
DATE
Id -?.D la
V Pface s%mp or sad ham V
❑ Check box if restrictions on the location
approval are in an attached letter from
APPROVED
the zoning authority.
CIfY OF SPRINGFlEID