Permit Support Document ,� /2� JUN2
City of Tigard ® COMMUNITY DEVELOPMENT D P/R?rMEN..
i. 1 d 202 CITY OF TIGABG
r Permit ct BUILDING DIVISION
Requestt.
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,, ; ,,. l k 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 TigarrlBuildingPertnits(tigard-or.gov
FROM: E. Owner ❑ Applicant 0 Contractor ❑ City Staff
Cheek(1)one
REFUND OR Name:
INVOICE TO: {Busies nr Individual) & >-P 1 12 t--L
Mailing Address: 1 c:;'..q. >`) ( c-Cl-fi A.
City/State/Zip: 1 1 >11N.(/---1-5 C)& 67')" /.2_2.` -
Phone No.: (.. _ .7�- �- L
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (1):
A. CANCEL/VOID PERMIT APPLICATION.
u REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: Cat N -- 50A..aago -60I5
Site Address or Parcel#: G-7 7 2 3 G.774 !'in) V l v—W cY A� T t 6r76Q,A. e z Z,
Project Name: i—R,"4 L-L.._ ,6.,s--n-AC_C-F cam(
Subdivision Name: • Lot#:
EXPLANATION: P L V `C C_ t_-- '‘k-- -i-- r Pt. 1 L oci l ori-Fr �
J(2, •T--) 1 \ T G Cr.
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Signature: Date: (o - z. - 2-.0 Z 1
Print Name: __p P c.y ‘ r- i L
Refund Policy
1. The city's Community Development 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 KM 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 fcren of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Ii i {,ii :it f li I I - ( Kt'• i ,,
Route to ays iix n: Date By Route to Records: Hate /� .t 4Refund Processed: Date A//ei- B Invoice Processed: Date By
Permit Canceled: Date 9//,a-/2.. By .) Parcel TaR Added: Date , By
1:\Budding\Forms\itegPermitAcriun_ 51 s.foe
Dianna Ornelas
From: #Building Permit Technicians
Sent: Tuesday,June 22, 2021 10:50 AM
To: Percy Traill
Cc: #CD PoD
Subject: Trail) ADU - 9772 & 9774 SW View Terrace - Void Permits
Hello Percy,
I am confirming that we received your request to cancel all land use and building permits for this project, and all plans
have been pulled to void the permits.
Since planning review was completed on the ADU,there will be no refund processed. For building permits, because plan
review had not been completed, there will be no invoice for fees due on the building permits and we will proceed to
void all permits.
We are sorry to hear that your project has been cancelled and we wish you all the best on your future projects.
Thank you and please let me know if you have any questions.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
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