Permit Support Document.... -. .. . .. . _ . . - Rq ..
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 1 ;;,;
11,1 4
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 ❑ Contractor R City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/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).
Permit#: /1 2-0$'d--u(i)7'1
Site Address or Parcel#: /Colo 5'5-- Si.J („i n h pc, Lam,
Project Name: ,502.....Th ii rc.' �e
Subdivision Name: .Q1, , , %cvyz.,,.“_ $ot#: f?,_kyv-)
EXPLANATION: `/
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Signature: G9� e....- 9 - Date: ,3A
Print Name: / —7-
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
Route to Sys Admin: Date 3/.q/yl By 1.;Z— Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date NIrs.VZZ By VIEI Parcel Tag Added: Date By
I:\Building\Forms\RegPernutAction_120518.doc
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
: " Transmittal Letter
T l G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: ov't DATE RECEIVED
DEPT: BUILDING DIVISION E
SEP 2 2 ZOZZ
FROM: IL G Svin w A r 14-1,rI.,
CITY OF TIGAHU
COMPANY: p a t k f i(, cs i BUILDING DIVISIc
By:
PHONE: So 3 33 2 3-7 t l
EMAIL: ��L �' PAc,�f -. C�{nnv►� in��/ . w(-vv.)
PLM 2022- or)o --
RE: 50 rft. FAVcr �'�rrem,t. Pcrto. A. PLivM -vvu8
• (Site Address) (Permit Number)
(/GS00S4) / ut/ 4l4 :;ws7>(// .
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
1 Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: S,bwt; vt 2 . c\rY .s(As d+63 r}-o.l I iAKs wLt, �� kavc
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FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions_073120.doc
Pacific
Community
Design
Transmittal
DATE: September 22, 2022 EI .
TO: Don Sylvester SEP 2 2 2022
City of Tigard CITY OF rI(aAliL
13125 SW Hall Blvd 3UILDING DIVISIGr
Tigard, OR 97223
RE: South River Terrace Area A - Plumbing
PROJECT NO: 395-103
Via:
® Messenger: ❑ Mail ❑ Overnight ❑ Pick-up ❑ Electronic
Rush / Route
❑ Fax pages (including this page) Fax No.
Transmitted:
® FOR APPROVAL ❑ FOR REVIEW AND COMMENT
❑ FOR YOUR USE ❑ AS REQUESTED
Attached:
COPIES DATE DESCRIPTION
2 Full size set
REMARKS:
SIGNED:
KC Schwartzkoph
Mail: 12564 SW Main Street, Tigard, OR 97223 Phone: (503) 941-9484
Website: www.pacific-community.com Fax: (503) 941-9485