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M-936A (11-17). OVERSIZE/OVERWEIGHT PREVIOUS. APPLICATION FOR SPECIAL PERMIT NO.: HAULING PERMIT. ''ALL LINES (EXCEPT DASHES) MUST BE COMPLETED" APPLICATION ID: TYPE PERMIT REQUESTED: Single Trip Single Trip & Return Annual Seasonal _____months Emergency Preliminary Superload Final Superload _____ of _____. PERMIT OFFICE_____ NAME_____. REGISTERED NAME (Responsible Motor Carrier). ACCOUNT STREET_____. MOTOR CARRIER/PERMIT SERVICE ADDRESS. FEIN/SSN_____ CITY-STATE-ZIP CODE_____. IF NO MOTOR CARRIER ACCT. NO. 1 = IMMEDIATE PAYMENT. 3 = MONTHLY BILLING. BILL CODE_____ 4 = GOVERNMENTAL CHECK/MO # CHECK/MO #. PERMIT FEE. <. GROSS WEIGHT_____ (lbs.) LEGAL WEIGHT = _____(lbs.) TOTAL LENGTH <. _____(ft.) _____ (in.). <. TOTAL WIDTH _____ (ft.) _____ (in.) =_____(ft.)_____ (in.). BODY WIDTH (63A/63B)__ <. TOTAL HEIGHT _____(ft.) _____ (in.). LOAD_____ _____ _____ _____.

For example, list serial number for modular unit section or unregistered vehicle being hauled (e.g., 12345A) and the bill of lading number for steel plates. ... Crane (self-propelled) < 100,000 lbs – Seasonal – Not obtainable thru a Permit Service – No refunds 35B . . . .Crane (self-propelled) > 100,000 lbs – Seasonal – Not obtainable ...

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  Self, Modular, Propelled

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