Permit Support Document 4/11/2022
American Heating
5035 SE 24th Ave
Portland OR 97202
Re: Permit No.: ELC2021-00717
Site Address: 10260 SW Greenburg Rd 550
Project Name: KPD Suite 550
Dear Applicant:
The City of Tigard has received your request to cancel the above referenced permit. The
status of this permit indicates that inspections were already completed prior to the request to
cancel. In accordance with our policy,we are unable to grant a refund of your payment that
covers work already performed.
If you have any questions,please contact me at 503.718.2470.
Sincerely,
Holly Van De Wege
Program Development Specialist
City of Tigard ' COMMUNITY DEVELOPMENT DEPARTMENT
111 " Request for Permit Action
TIGARD 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 n Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) 1 `i t1 lrt. \.,t
Mailing Address: 5 Q 3 5 S E, c q 4*\** v-e,
City/State/Zip: ?AA-1 e:414 Q • '1 "2 ZA Z
Phone No.: SJ" a 5 -,Q 3 q u n C}
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V):
el CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
al INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit #: QLC, Cal 1 -- d 0 3 t 1
Site Address or Parcel#: 10.2 ER CI 654.4 Gyb.Atztv.es
Rd • J5 ti
Project Name: I'd) J S V.. i-k. 550
Subdivision Name: •Mt3C- „p,(,r d �'} Lot #: q
EXPLANATION: 0 t-sstck y i xse, l y'e
i
Signature: --L„ Date: 1 ~v 7•
Print Name: 'C„+54-
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Boilding\Forms\ReyPermitAction_120518.doc