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HomeMy WebLinkAboutPermit Support Document (2) CityT COMMUNITYRECEIVED ihi of gand • DEVELOPMENT DEPARTMENT JAN 2 7 2020 Z Reque •t for Permit Action CITY OF TIGARD f t t;A 12 D 13125 SW Ha I Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.govlLDiNG DIVISION TO: CITY • TIGARD Buildin;, Division v1 0 13125 S 10 Hall Blvd.,Tigard,OR 97223 /,2-7/26 Phone: 513-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: FRO✓)one ❑ Ow er El Applicant ►r Contractor ❑ City Staff REFUND OR Name: INVOICE TO: (Business or r dividual) J Efx j Saver La+ Mailing Address: Wes+ ox ass '^ City/Stat /Zip: Ere9(r) cup,., a q- q5 Phone N : i)b3. 2,9 . (05 20 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PE T APPLICATION. Er REFUND PERMIT F ES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEE DUE (attach case fee schedule and provide explanation below). Permit#: t EC 201q_ 003q 2 Site Address or Parcel : C Dt 5 S G0 Wes-Hurd 1 u Cif-, Project Name: F 1( 1 41.r9 Subdivision Name: Lot#: EXPLANATION: :)1) c� CO n(�I led �.J �J Signature: «G MideA Date: 1an 2 7, 2_02_0 Print Name: lie yoeder 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 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. /t • itO — p-,6y /oV-i-d c=©. 6, L, ,2r,,'40 FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date B Refund Processed: Date / ��� By nvoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date B I:\Building\Forms\RegPemutActio l 1 .doc Y L� 1