Correspondence May 09 2008 11:22RM Bridgetown Electric 503 -821 -7123 p.1
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i � 1 n Comrnuni Development 0 r ° - =:h
N.4,4 lis FA ' ,A1�., Request for Permit Action 3 }
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TO: CITY OF TIGARD CITY 1,.'-,:' ;
Suilditng Division Services Coordinator BU r ` �' `�
y l a }� ,,� ,:';;MT-.'
13125 SW Hail. Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 wrrw•tigar.•d•or.gnv
FROM: ❑ Owner ❑ Applicant g C;ontractot ❑ City Staff
(cheek no
REFUND OR Name: O a � L vtdt11) 6
Mailin Address: 0 - �7'I W ` 12,40c--
ethfri&G SC � OF City/State /Zip: Pc)--q-C.,,,p,-.." !
A) 0 2 k VA Pbonc N,.: L 513 Ca Z/ - 7 / )-
410
.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (r):
' ❑ CANCEL. PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
0 0 E R FEES DUE (attach case fee schedule an explain below).
is r&- ovRACTOR FROM PERMIT (do not cancel permit).
G P ELL 100 — 60 1 D
Site Addrm or Parcel #: { 711 S (A) ( 1 cL oN P
Project Name:
Subdivision Name: -1114 Lot #:
EXPLANATION: W - L IVbK OU 1 S ' r!k -c.L 4 y � st Po c.f-.-
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�, ilgnaturc: t At + ; i Date: 5- -� pun- .'- {
Print Name: iin -i `t rt.sti"°t- � as butrit
$nruno Pntic � J 6 -en,t ci.,, f /..41-1
I. The Director Car Building Official rmf aurhntiae tlto tcfend nil Mr -C-0( d11 3 / . 7/o
A) on/ fee twldd. WO ertenonetly paid ar enllected.
b me mote than RX% o f the tint Lire apphentinn fee when nn 4pplicatimt iA Withdrawn or caneekd b :frtc Any review a;ffort bait loon trendal. h - 7 24 ny )
c) not more Chin KS of the larul'me applicat fee for i.stied permits. f � ^
Cry 'tot more than ffIr. of the building plan rcriew (we when on Application i. canceled before nny pier rcr icw cRur hn. been impended, 4 0 t
c) r, %I: .'rote than At % of the 1attiIJing petmir fec fug idol('trermitrt orlon w m rimy ■nrpeeturn rcqucn .
2. Refimaht will be renamed to rho orgpnnt Pmzr in the tare . shod in .which payment w& received, Plc. t allow 1 weekr tie proccrsmg refunds. ..
1 Attain: Dare Rte f'e, ±T +t`.:�')sly�F Rte t.1 $t p , Ad Date �
d 9 ep- By ... 1067a11 .Refund Pmcessed: Dat Invoice Processed! Date B
Permit Canceled: Date Il GEMEMZEIM 1) ate By
Rcccip # Date Method Amount $
1:\ Build ,nit \rornAk4ecrmic Rev n7f26l _ A ' r , c ,......
. kdt .... u .A ft ...a t C___Aft_a_ rYLA-.-- / 17 kLetiPe L e 40 e v,..a,(--14,..,7:7"1--ct
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