Permit V 0 I L;
9///7-, ' L
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
UPI Request for Permit Action
T I .;A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: BUP2020-00200
Site Address or Parcel#: 10260 SW Greenburg Rd, 900
Project Name: Guild Mortgage
Subdivision Name: Lot#:
EXPLANATION: BUP created in error instead of MEC.
BUP2020-00200 replaced by MEC2020-00593
Signature: Date: 09/09/2020
Print Name: Eggie Maldo a o
Refund Policy
1. The city's Community Developme Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date, Ce/2,.f By / C
Refund Processed: Date Bier Invoice Processed: Date By
Permit Canceled: D 7 `�/ B Parcel Tag Added: Date By
I:\Building\Forms\ReyPcrmitActiateon_1 051 .doc