Permit Support Document 4/11/2022
Lightworks Electric Company
20915 SW 105th Ave
Suite A
Tualatin OR 97062
Re: Permit No.: ELC2021-00511
Site Address:
Project Name: Donna Park
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 Wege
De Wge
Program Development Specialist
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III = I
Request for Permit Action
1 t t.,,\1z l I 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • \v\v\v.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(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Lightworks Electric Company
Mailing Address: 20915 SW 105th Avenue Suite A
City/State/Zip: Tualatin, OR 97062
Phone No.: 503-691-2959
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
Q REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit #: ELC2021-00511
Site Address or Parcel #: 1S133DC00400
Project Name: Donna Park
Subdivision Name: Donna Park Lot#:
EXPLANATION: Originally we were installing an electrical 200 amp or less service and circuit for lights.
Our scope of work changed,we are no longer installing service and circuit for street light. Please let me know
if you need anything for this request. Thank you
Signature: Ai y Zcteh. Date: 2/1/2022
Print Name: Ashley Guile
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 2 1 -Lt. By Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
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