Permit Support Document 1
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��+ City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Q
171 h _. Request for Permit Action
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TIGARD 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www.tigard-or.gov ` .>
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3 ' . TO: CITY OF TIGARD gg y / (�
, Building Division R E u r 4 i E t..•°
13125 SW Hall Blvd.,Tigard,OR 97223
,� Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-ot nv '-
2 _' FROM: Ej Owner ❑ Applicant ❑ Contractor ❑ City Staff .,DIVISION` {H�
3 ,. Check(✓)one
T S m REFUND OR Name:
INVOICE TO: (Business or Individual) A,,k -v.,,.. A 4200 , t tC
r c Oda. Mailing Address: i'. JD, Q o:( 2-i
CCity/State/Zip: Redlf, -kOti t C f2__ 9 -0 '4--c'
f< Phone No.: c D — 0 6 Q (; .
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nPLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(1):
.1 CANCEL/VOID PERMIT APPLICATION.
`k. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
N -A r xi INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
_? `; Permit#: l30P 2-020 .-D0O2,3
Site Address or Parcel#: ,, 5-y.7 est v Jv`aC* ,�-fpot
S 3 Project Name: /601 R 'C'f(q (yr '6 G2-9 cn,J yyt,Qan
-. Subdivision Name: Lot#:
ll - c EXPLANATION:
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�� Signature: r� Date: �,_ I a_ 2 0 2 2
Print Name. /( 27" SGtlir)P,r:Y,Lo t
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 pesn its 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.
Route to Sys Admin: Date S j p%y) By err Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date VI q Ark By KA,Parcel Tag Added: Date By
I:\Building\Forms\RegPemiltAction.j 205I .doc
Branden Taggart
From: Branden Taggart
Sent: Thursday, May 5, 2022 4:10 PM
To: ralphtahran@comcast.net
Cc: Holly Van De Wege; Sean Farrelly
Subject: Ava Tigard Plan Review Invoice: BUP2020-00025 - 12547 SW Main St.
Attachments: Reg PermitAction_120518.pdf; BUP2020-00025 FLS Plan Review Invoice.pdf
Hi Ralph,
We will be voiding the first Ava Tigard Building permit BUP20220-00025 for the four-story building. However, we had
already completed the Fire Life Safety plan review prior to receiving the second permit submittal. Therefore, we will
need to receive payment in the amount of$8,981.10 for services rendered. I have attached an invoice above for
reference. This fee can be paid in person or online through our website https://aca-
prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number BUP2020-00025 under the Building
tab.There is a 3%service fee for credit cards, but e-checks do not have a service fee. Furthermore, we will need you to
complete the attached Request for Permit Action form and return it to us so that the permit can be voided.
Thank you,
Branden Taggart
711 it City of Tigard
I . Senior Permit Technician
Community Development
S€t'Aic1:a
13125 SW Hall Blvd
Tigard, OR 97223
(5O31718-2449
bra ndent@tigard-o r,goy
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