MMD2018-00023 City Tigard • COMMUNITY DEVELOPMENT DEPARTMENV
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Request for Permit Action ;/zZ/I' . --
1 1 t;;1 i,I, 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(1)one
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0 riEFUND OR Name:
INVOICE TO: (Business or Individual)
clAe 1 i7(�ln Mailing Address:
e- }hiS City/State/Zip:
9trr,;T. Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
D/CANCFI /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).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: h W 20ln- ood ,3
Site Address or Parcel #: Z S l l`I A C V D o J 0
Project Name:
Subdivision Name: 14Z AV st>b 1 I+ Lot#:
EXPLANATION: 1 ac[ibt4411 Ccta a lit g Cad ijtai or a, QRi C. f R.0 ,dig-00022)
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Signature: y-R 4"i.. U C l7 ZL - Date: S.-31-I
Print Name: ,S'atr•w-c l (u et a,.
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY _
Route to Sys Admin: Date By Route to Records: Date # 2-2-- Arc— B y
Refund Processed: Date /✓ .4- B .IA Invoice Processed: Date By
Permit Canceled: Date 0/2// By , Parcel Tag Added: Date By
1:\Building\Forms\RegPemiitAction_ 9231 .doc
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Frontl DSTS
Subject: PRE2018-00022
Location: CR - 1 Permit Center
Start: Tue 7/3/2018 9:00 AM
End: Tue 7/3/2018 10:00 AM
Recurrence: Weekly
Recurrence Pattern: every Tuesday and Thursday from 9:00 AM to 10:00 AM
Meeting Status: Meeting organizer
Organizer: -Pre-Apps_CD_Meetings
Required Attendees: #Pre-Application-Conferences
Optional Attendees: Jessica Williams;Al Dickman;Albert Shields; Brady Bullinger; Dylan Bemis
Resources: CR - 1 Permit Center
Call Handling Mode 2: 2
The applicant is considering two different projects for the site. The first idea is a planned unit development/11 lot
subdivision for single-family house. The second idea is an assisted living facility. Both would have access from Riverwood
lane and both would install a pedestrian pathway through the site to provide connectivity to 92nd Ave.
1