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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Reimbursement District Payment Worksheet
TIC A R I) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 11990 SW 72nd Avenue
OR
Reimbursement District#: 46 Parcel 1 S136DC04402
#:Amount Due: $25,913.14 Amount Due Expires On: 3/14/2021
Applicant: Dartmouth Apts Daytime Phone-
Email Address:
❑ Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee,if applicable)*
By: Mai/Quack Date: 8/10/2020
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
cz., *If a server loan is processed, wait forjournal entry before creating pinmbing and sewer permits.
Reimbursement Amount Paid: $025 41/3,/y Receipt#: 1/30s2r3
SWR#: -Sk ,Q.�O� -eve 73 PLM #: .2Q d - etc)/S?
Enter parcel conditions in Accela (check all that apply):
[ ter"paid" condition.
Enter "deferral" condition,if applicable.
By:
Date: g//0/21)
Name
Printed: 8,ceiVaeA.1
Attach this worksheet to issued sewer permit for records scanning.
I:1Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Reimbursement District Payment Worksheet
T 1 G A R D 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 11860 SW 72nd Avenue
OR
District #: 46 Parcel 1 S136DC04100
#:Amount Due: $16,850.18 Amount Due Expires On: 3/14/2021
Applicant: Dartmouth Apts Daytime Phone-
Email Address:
Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee,if applicable)*
By: Ma i/Quaclv Date: 8/10/2020
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
^c^ *If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
h Reimbursement Amount Paid: $ /4, ' 50, /3 Receipt #: if 3 Os 8'3
SWR#: SteI2 O2Oao -000 73 PLM#: j -012/53
tt
v Enter par onditions in Accela (check all that apply):
Enter "paid" condition.
\ ❑ Enter "deferral" condition,if applicable.
By: .,..._.,::5,37">
Date: 0 d
4/-zi
Name
Printed: i574i/e4t) - yam,
Attach this worksheet to issued sewer permit for records scanning.
4t
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
INn Reimbursement District Payment Worksheet
T 1 G A R p 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 11930 SW 72nd Avenue
Reimbursement District#: 46 Parcel 1 S136DC04300
#:Amount Due: $22,641.20 Amount Due Expires On: 3/14/2021
Applicant: Dartmouth Apts Daytime Phone:
Email Address:
Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee, if applicable)*
By M Quach. Date: 8/10/2020
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ A1-1 Qj Receipt #: 4005E3
SWR#: 0OO 73 PLM#:e, j;2p
Enter par conditions in Accela (check all that apply):
Enter"paid" condition.
❑ Enter "deferral" condition,if applicable.
By: Date: 3'/4
Name YS
Printed:
Attach this worksheet to issued sewer permit for records scanning.
4
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
11111 = Reimbursement District Payment Worksheet
T I G A R D 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 7140 SW Clinton St
Reimbursement mbursement District #: 46 Parcel 1 S 1 36DC04000
#:Amount Due: $17,684.25 Amount Due Expires On: 3/14/2021
Applicant: Dartmouth Apts Daytime Phone-
Email Address:
❑ Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee, if applicable)*
By: Mat'QuacTv Date: 8/10/2020
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ 17) (on, Receipt #: 4,3O5,K3
SWR#: ,2-e 000 73 PLM #: ^ TKO/33
Enter par 1 conditions in Accela (check all that apply):
Enter "paid" condition.
4 Enter "deferral" condition,if applicable.
By:
%! �•P�—' Date: 8/Gt}/az1
Name
Printed: �'�,tv`(� � �,,�9--
Attach this worksheet to issued sewer permit for records scanning.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDefcrrcdAccounts_041918.docx
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
= Reimbursement District Payment Worksheet
T I G A R C) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: Vacant
Rennbursement District #: 46 Parcel 1 S136DC04200
#:Amount Due: $16,740.52 Amount Due Expires On: 3/14/2021
Applicant: Dartmouth Apts Daytime Phone:
Email Address:
❑ Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee, if applicable)*
By: Maw Quccch, Date: 8/10/2020
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
s,
*If a sewer loan is processed, waitforjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ /6,-740, Receipt #: 430573
SWR#: cL LL€? -ppp PLM#:.2v-ao OQ/S3
Enter parcel conditions in Accela (check all that apply):
Enter "paid" condition.
Enter "deferral" condition,if applicable.
By:
Date: gik.,07j
Name -",
Printed: �—
Attach this worksheet to issued sewer permit for records scanning.
I:1Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx