Permit Support Document RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 2 3 2019
CITY OF rIGARD
: * • Request for Permit Action BUILDING DIVISION
TIGARD 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 • WWW.tigard-ongov
TO: CITY OF TIGARD V 0 I D
Building Division
13125 SW Flail Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildirtgPermits@tigard-or.gov
FROM: ri Owner 0 Applicant . Contractor El City Staff
Check(V)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Garner Electric Washington LLC
Mailing Address: 402 Valley Ave NW Ste 106
City/State/Zip: Puyallup, WA 98371
Phone No.: 253-872-6051
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPLICATION.
El REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
(67
' El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: ELC2019-00478
Site Address or Parcel#:
Project Name: Willowbrook
Subdivision Name: Lot#: 6
EXPLANATION: Garner did not need to pull separate electrical permits as they are issued under a
combination permit(MST)when the general contractor or developer obtains the permits.
Signature: _a-LUC( lat Date: 7/23/2019
Print Name: Alicia Gentele
Refund Policy
I. 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. / _ 7 7 0 _ "-a,sk 7._, Aer • fy
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FOR OFFICE I, SE ONLY
Route to Sys Admin: Date-4\,,4 By lia- Route to Records: Date ..)..7 / By 4' %
Refund Processed: Date ,fp- / By Invoice Processed: Date By
Permit Canceled: Date typ- /9 By 'gim'--Parcel Tag Added: Date By
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