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HomeMy WebLinkAboutApplication Applicant 6/6/2023City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 i RINGFIELD LAND USE COMPATIBILIITY STATEMENT (LUCS), DEPARTMENT OF MOTOR VEHICLES (DSIV) and ZONING VERIFICATION LETTER Application form Permit Type Dept of Motor Vehicles -New: Land Use Compatibility Statement: ❑ City: ❑ Dept of Motor Vehicles -Renewal: ❑ Zoning Verification Letter: ❑ UGB: Project Information Applicant Name: 4 (0 RF�c0V r-�L Phone: r5'�J ❑ r� _ V"V 1 Company: HT1✓ C.Gfz E-mail: Address: r7q M&atowH- POAO 6PAI IN &fl r�,G4 ok 2 q q r? Property Owner: I u ,pOi'L - Phone: fql c/5__/ - Company: Com an : �e� �(YTm 2ise, E-mail: �' I % f ►•u,/,gym,. Address: ` 1177 ASSESSOR'S MAP NO: M23090 Property Address: 5 �71/ r7/2Cpc,f ITAX LOT NOS : 6'701 � Z ' 7 Description of proposal/ request: i Record• to complete Record No: �� .a r"l— () 0D 3 L r I I Date Received:IQ ) Application Fee: JLO5 00 Technical Fee: $ TOTAL FEES: $ 3�3 a 5 Assigned Planner: 'K Revised 2023 04 04 shn 1 SUPPLEMENTAL low Jim DEALER / REBUILDER VEHICLE OEPARTMENTOPTRANEPORTAl1ON URNERAME, SALEM OREGON DEALER CERTIFICATE APPLICATION 1OR IRNA AVEAYE NE, R VEM OREGON ICES + All supplemental locations must operate under the same ownership and business name as shown on the current certificate. (ORS 822.040) ® Submit application with all required signatures and fees to: Business Licensing Unit, 1905 Lana Avenue NE, Salem OR 97314 + Any alteration of Line 2 voids location approval. Check if: ❑ New Vehicles ❑X Used Vehicles 1 BUSINESS NAME United Access SUPPLEMENTAL LOCATION (STREET AND NUMBER 2 3574 Marcola Road MAILING ADDRESS 3 500 Northwest Plaza Dr., Ste 900 41 MAIN BUSINESS LOCATION 5170 NE Five Oaks Drive, Hillsboro, OR 97124 DEALER NUMBER EXPIRATION DATE EFFECTIVE DATE FEE: ❑X $350 FEDERAL EMPLOYER ID NUMBER BUSINESS TELEPHONE 43-1941064 1(541 ) 726-4001 CITY COUNTY ZIP CODE Springfield Lane 97477 CITY COUNTY STATE I ZIP CODE Saint Ann Saint Louis MO 63074 ON — Must be sinned bv the dealer— False certification is a Class B misdemeanor under ORS 162.085 and is punishable by six months in jail, a fine of up to $2,500 or both. In addition, DMV sanctions against you or your dealer certificate may be imposed. With the above penalties in mind, I CERTIFY: I am the owner, a partner of a partnership, an LLC member, or a corporate officer of this business entity, and that all information on this application is accurate and true. This business deals in vehicles, or rebuilds vehicles at the location given. This supplemental location will operate under the same ownership and business name as shown on the current certificate. PRINTED 5 I TITLE 5026 _ —A .1fi 6 SIGNATOR f E-MAIL SUPPLEMENTAL BUSINESS LOCATION INFORMATION 7 Property is (check one): ❑ OWNED x❑ LEASED / RENTED: LEASE OR RENTAL PERIOD: If property is "Leased / Rented" complete the following: YKUVLK I Y UWNI=MS NULL NAML SI DUGDALE ENTERPRISES LLC YKU466r'tKMAl Y UWNLK'S AUUKt55 9 NSFIELD ST CITY STAT SPRINGFIELD OR LOCATION APPROVAL — If renewal, see instructions — 97477 Certification of Local Zoning and Business Regulatory Compliance. 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. Your approval below should be based upon whether the applicant can do ANY of the activities listed in (a) through (c) above under your ordinances, at the location of the business given on Line 2. Pursuant to ORS 822.025(6), applicant meets requirements below. As the zoning official for the locality in which this business is located, I verify by my signature below that the location of this business as stated on this application complies with any land use ordinances and business regulatory ordinances of the city or county, as appropriate pursuant to ORS 822.025(6). TELEPHONE NUMBER 11 1-1 CITY OF: ❑ COUNTY OF: 12 PRINT NAME TITLE 13 SIGNATURE X ■ Place stamp or seal here V DATE