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
❑
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Company: HT1✓ C.Gfz
E-mail:
Address: r7q M&atowH- POAO
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Property Owner: I u ,pOi'L
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Phone: fql c/5__/ -
Company:
Com an : �e� �(YTm 2ise,
E-mail: �' I
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Address:
` 1177
ASSESSOR'S MAP NO: M23090
Property Address: 5 �71/ r7/2Cpc,f
ITAX LOT NOS : 6'701
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Description of proposal/ request:
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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