VAR2007-00041 ° Community Development
Request for Permit Action
TIGARD
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
V 0 1 0 Mailing Address:
. City/State /Zip:
/HOP
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
® CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: VAR2007 -00041
Site Address or Parcel #: 15760 SW 76 Avenue
Project Name:
Subdivision Name: Knauss Subdivision Lot #:
EXPLANATION:. Variance was not needed. The applicant dedicated the required amount
of right -of -way and a curb -tight sidewalk within sensitive lands does not need an adjustment to
the street improvement standards. Ni f 5 /C — NO 4-1:7: A/2) A9C, c -I /' yd,, ,
Signature: (./J --' C C e --: Date: 1/2/08
Cheryl Gaines 0.,...A.,
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. •
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment wa�
�_ ,
y received. Please allow 1 -2 weeks for processing refunds.
l .oR orrlCL_USE ON LY _�_� _
Rte to Sys Admin: � Date By Rte to B1trg Admin: Date if:e" eV By [f' - ' 00r
Refund Processed: Date 1 ✓/ 1 1 - By/ - Invoice Processed: Date By
Permit Canceled: Date 7'/ �/'oJ By4' Parcel Tag Added: Date By
Receipt # Date // Method Amount $
I: \Building \Forms \RegPermitAction.doc Rev 07/26/07