Plans M ec &-oo/ /
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
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January 5, 2011
Erin Wilde
12550 SW 134t Ave.
Tigard, OR 97223
Re: Permit No. MEC2010 -00117
Dear Erin Wilde:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12550 SW 134 Ave.
Project Name: Wilde •
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $80.64.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request and project was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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Dianna Howse
Building Division Services Supervisor
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I:\ Building\ Refunds\ Administration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
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City of Tigard
T cn RD Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Erin Wilde DATE: 12/28/2010
12550 SW 134 Ave.
Tigard, OR 97223 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 177275 Case #: MEC2010 -00117
Date: 03/19/2010 Address /Parcel: 12550 SW 134th Ave.
Pay Method: CreditCard Project Name:
EXPLANATION: Per applicant's request due to lack of funds to complete project.
REFUND INFORMATION, ,
Fee; Description From Receipt _ ' Revenue Account No ` „ Refund
Example: Building Permit Fee „Example :2300000-43104 $ Amount
Mech Permit Fee • 2300000 -43102 $72.00
12% State Surcharge 1003100 -24001 8.64
TOTAL REFUND: $80.64 a
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager L. /,
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
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FOR TIDEMARK SYSTEM ADMINISTRATION USE ,ONL
Case Refund Processed: I Date: I //SA, I By:
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
12-08-2010 12:55 DANIELLE WILDE 5035241039
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