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Permit Support Document From: 02/28/2020 09:19 #048 P.001/001 RECEIVED 74 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT FEB 2 St VtS 2020i Request for Permit Action CITY OF TIGARD ILDING DON TIGARD 13125 SW Flail Blvd. •Tigard, Oregon 97223• 503-718-2439 •www.tigard or.govBU TO: CITY OF TIGARD Building Division goe 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@tigar( r. � FROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff Check V)one REFUND OR Name: INVOICE TO: (Business or Individual) M AND W ELECTRIC Mailing Address: 29889 SW HWY 34 City/State/Zip: ALBANY OR 97321 Phone No.: 541.754.6171 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): © 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#: ELC2019-00063 Site Address or Parcel#: 9860 SW RIVERWOOD LN Project Name: ADD DEDICATED CIRCUIT FOR THERAPY BATHTUB./ T,eI e?/C.1 Subdivision Name: PICK'S LANDING NO.2 Lot#: 73 EXPLANATION: M &W Electric never performed any work at this address.We obtained the Permit and the job was then cancelled. Signature: Date: 2.28.2020 Print Name: Mike Weaver Refund Policy I. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fce 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. �! / /� y r^Y 1o.2_9 S 3 "; -C.: lrO!ZC)FF I('l: I si f)\L\ Route to Sys Admin: Date By Route to Records: Date 9r5 Z/ ; l� Refund Processed: Date 3/2p�'2,0 By Invoice Processed: Date By Permit Canceled: Date a2p2y By' Parcel Tag Added: Date _By I:\Building\Forms\ReciPermitActinn_t 0518. oc