Permit Support Document City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III r
Request for Permit Action
i I ci A R D 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: El Owner ❑ Applicant ❑ Contractor ❑✓ 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 (✓):
❑ 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 #: MST2022-00036
Site Address or Parcel#: 7720 SW BONITA RD
Project Name:
Subdivision Name: Lot#:
EXPLANATION: PERMIT CREATED AS RESIDENTIAL (MST) INSTEAD OF COMMERCIAL
(BUP) MST2022-00036 REPLACES BY BUP2022-00047.
Signature: d���� Date: 02/22/2022
Print Name: E•gie M:Idonado
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 Z 1.Z-'ZL- By e.ty‘ Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date 4'1 k-t-g- By 11/41 Parcel Tag Added: Date By
1:\Building\Forms\RegPermitAction_12051 .doc