Correspondence CITY OF TIGARD
s Building Division
l 1 G A I:D 13125 SW Hall Blvd.,1'igard,OR 97223 503-639-4171
INVOICE
TO: Day Road Design Group Customer ID: C08-0001
9825 SW Day Road Invoice No.: INV2008-00001
Sherwood, OR 97140 Invoice Date: 1/15/08
Attn: Ron Kief Date Due: Upon Receipt
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
BUP2006-00378 13500 SW Pacific Hwy,Ste 90 Tan Rio $494.34
Invoice Total: $494.34
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: BUP2006-00378 Customer ID: C08-0001
Site Address: 13500 SW Pacific Hwy, Ste. 90 Invoice No.: INV2008-00001
Project: Tan Rio Invoice Date: 1/15/08
Date Due: Upon Receipt
Invoice Total: $494.34
Amount Paid: $
Office Note:
Please mail payment to:
City of Tigard, Building Division
13125 SW Hall Blvd.
Tigard, OR 97223
Attn: Dianna Howse
I:\Building\Accounting\Invoice.doc 04/06
CITY OF TIGARD 1/15/2008 -
" Fees Associated With 3:51:46PM
13125 SW Hall Blvd.
TIGARD Tigard,OR 97223 503.639.4171 Case#: BUP2006-00378
Fee Start End Revenue Created 1,,, r,.
Type Date Date Dept Description Account Number By Date Amount Due
PRMT 1/1/1990 12/31/2020 [BUILD] Permit Fee 245-0000-432000 DEB 8/9/2006 470.80 470.80
5PCT 1/1/1990 12/31/2020 [TAX] 8%State Surcharge 100-0000-207020 DEB 8/9/2006 37.66 37.66
PLCK 1/1/1990 12/31/2020 [$UPPLNTP1n Rv -----"'• 245-0000-433000 DEB 8/9/2006 306.02 306.02
FIRE 1/1/1990 12/31/2020 [FLS] FLS Pln Rv am/ 245-0000-433020 DEB 8/9/2006 188.32 188.32
Total Due: $1,002.80
ryy , I,
/ /10 Vi C1471n '&7(4-41 — Jew ) /dv .4_, / .Ecr) 4 r t
>,�,tir7/7 .4-1.., it-2 14/4 d.
Page 1 of I CaseFees.rpt
IN
n
Community Development /aoo�'
Request for Permit Action
TIGARD
10: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 14 City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) "I\A,� 6AD 'i S1G.✓ I L t-C.
Mailing Address: :: Q by S k1 p,-Ni S r Su 1 TV 2.up
City/State/Zip: PO,,7_,A,,,z,1 ote 97.10,f
Phone No.: ($-O3) 22...t- g7° ,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ 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#: eS M iD D.W(, — pv 3 ? k
Site Address or Parcel#: /3 Coo SH! VA C..7 F_TL /-ft/y-, Su-3-7"-c_ 90
Project Name: cJ?4 A.L
Subdivision Name: Lot #:
EXPLANATION: N f Jt 2 es,k e t4 P,
,AN 'ZE11-1-Fw ties - Lf9q . Sy
Signature: '1"t'tk V'^ Date: /_/y_as
Print Name: BALK VAN boMtIre J
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°'o 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°o 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 was received. Please allow 1-2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date B Rte to Bld: Admin: Date B
Refund Processed: Date .t/ e9- B ?ff, Invoice Processed: Date /AF,,ra00d' B v=
Permit Canceled: Date v,$ oif By '€7, Parcel Tag Added: Date By
Receipt# Date Method _ Amount$
I:\Building\Forms\RegPermitAction.doc Rev 07/26/07