Permit Support Document City Of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
71111
■ Request for Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD Le 0
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223 .//)
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner E Applicant Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Parker Fire Protection
Mailing Address: 30205 SE Kelso Rd
City/State/Zip: Boring, OR 97009
Phone No.: 503-358-1034
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
[J 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#: FPS2022-00038
Site Address or Parcel #: 10770 SW FAIRHAVEN TIGARD, OR
Project Name: AVA Estates
Subdivision Name: Lot#:
EXPLANATION: There was a pause put on the new code that requires fire sprinklers
Signature: Date: 8/8/2022
Print Name: Joe Durbin
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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: Datek//I/),3\ By } Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120518.doc