MISSOURI DEPARTMENT OF TRANSPORTATION
MOTOR CARRIER SERVICES
830 MoDOT DR., P.O. BOX 270
JEFFERSON CITY, MO 65102-0270
PHONE: (800) 877-8499
WEB ADDRESS: www.modot.org/mcs
House Move License Number _______________________
House Mover License
Number Expiration Date __________________________
For official Use Only District Contact Information
____________________________________________________
General Information
USDOT #
Contact Person
Contact Phone Number
Customer Account Number
Legal Name of Applicant
DBA Name
Federal Identification Number
Social Security Number
Physical Address
City
Mailing Address
City
E-mail Address
Telephone Number
Send Permit How?
Fax Number
E-mail
APPLICATION FOR
HOUSE MOVE
Fax application to applicable District office:
St. Joseph 816-387-2359 Chesterfield 314-340-4508
Hannibal 573-248-2467 Springfield 417-895-7652
Lee’s Summit 816-622-0440 Sikeston 573-472-6591
Jefferson City 573-522-1059
Permit Cost - $265.00
Emergency plan in the event of a breakdown. (Required for all moves)
If loaded height exceeds 17’5”, must attach written documentation for all utility companies indicating approval to disturb aerial lines across the route. Documents shall include contact
names and telephone numbers for each utility company.
If loaded height exceeds 17’5”, must attach a list of qualified contractors approved by MoDOT that will be hired to adjust, modify, remove and replace state owned property such as
signal and sign mast arms, flashers, signs, etc.
If you will need additional law enforcement assistance for traffic control is required, you must provide a list with contact names and telephone numbers.
Completion of this application does not guarantee issuance of a permit. If any problems exist that may prevent the move from reaching its destination over the state
highway system, the application will not be approved.
Allow two (2) weeks to for a route evaluation.
APPLICATION FOR HOUSE MOVE - CONTINUED
Load Information and Dimensions
Description of Object
to be Transported
Width
Feet
Inches
Length
Feet
Inches
Height
Feet
Inches
Vehicle Information
Power Unit
License Number
State
VIN
Year
Make
Hauling Unit
VIN
Year
Make
Hauling Unit
VIN
Year
Make
Overall Dimensions
Overall Width
Overall Length
Overall Height
Feet
Inches
Feet
Inches
Feet
Inches
Route Information
Coming From:
Going To:
Route:
Certification
I DECLARE UNDER THE PENALTY OF PERJURY under the laws of the State of Missouri and the United States of America that the foregoing information in the application is true and correct, that I
am authorized to sign this application on behalf of applicant and that the signature below is my own true and correct signature made by me and no other person. If over 120’ long, I attest that a
representative from our company has physically driven the route to be used while traveling under permit and all turns, curves, etc. can be safely negotiated. I understand that if the Superload does
encounter problems negotiating such, my company will be charged a new bridge study and permit fees and may result in the denial of future Superload applications. I also understand that failure to run
survey will result in denial of this application.
Name (printed)
Date
Signature
Title
Required Attachments
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