SGN2016-00070 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN\ / r) ! „cep
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1 : Request for Permit Action 7/4/4
1.1 G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor IX City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) f-Kt. C j 0` 119 ore( , M I it1-c L v eC k-
Mailing Address:
City/State/Zip:
Phone No.: 1 j q - 2 5 cl 3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
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).
❑ REMOVE/REPLACE CON TRACTOR ON PERMIT (do not cancel permit).
Permit #: gel N 201 6 - 0 007 0
Site Address or Parcel #:
Subdivision Name: Lot #:
EXPLANATION: U O i & p fx �+ of P p I i coh-0.-1 , M ; O n o i-
e u I 1 ,.-- , p&'-on-11-7 .
Signature: /I/1 ,9' _ • ---_ Date: 7 12 7 / 1 6
Print Name: M o rl i t ti f3 o et-e ot .i
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
Route to Sys Admin: Date By Route to Records: Date 9 /4, //,
Refund Processed: Date �� By� Invoice Processed: _ Date By
Permit Canceled: Date 9 /4,/q, By Parcel Tag Added: Date By
I:\Building\Forms\Rey PermitAction_09231 4.doc
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Cityof Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
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Request for Permit Action
TIGARD 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor g City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) T1''-e- Li 0 (- -1-))0(7)(- / M 1 LC. - L u e C Lc
Mailing Address:
City/State/Zip:
Phone No.: 1 - 2 Sc-i 3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCF.I /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).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: EG N 2 01 b - 0 001 1
Site Address or Parcel #:
Subdivision Name: Lot #:
EXPLANATION: V 0 Cl- 9 Qif m; cU cL i' u,
Signature: Date: 7 /Z 7 l J V
Print Name: (V1 O n i Gh (3 t\o cL.
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 y//, /4. B !-7
Refund Processed: Date A//4— By ,;Ail Invoice Processed: Date By
Permit Canceled: Date 9//.//j By ,! . Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_pf2314.doc
(") 0City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
r Request for Permit Action 9// PG
TIGARD 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 7"" City Staff
Chcck(V)um!
REFUND OR Name:
INVOICE TO: (Business or Individual) C o` T D T U r--.l�1. M Lim c
Mailing Address:
City/State/Zip:
Phone No.: ' 1'b ,2.5 3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
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).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: S G N 201 (4 - 0 0 0-12
Site Address or Parcel #:
Subdivision Name: Lot #:
EXPLANATION: V 0 vs-6-1" M C 4-- v 'Lk ci(-
S ' ' p or-) , .
Signature: /\A 19�� �/ .—�_ Date: _ - / 1_7 / ( ,o
Print Name: MO el is— (11 o dtc_Gvt1
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 ti: /C, /A, By .
Refund Processed: Date /V/f By ;pp Invoice Processed: Date By
Permit Canceled: Date ittria, By J Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc`
V
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT a
Request for Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor gi City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Tha2
C-J(
P3M( L Ueck
Mailing Address:
City/State/Zip: p
Phone No.: 1 )9 -
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
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).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: SG N 2-7 1 -- 00073
Site Address or Parcel #:
Subdivision Name: Lot #:
EXPLANATION: v p id_ rev, p
pXr t .
Signature: 71/1 Date: 7 / - ? / 1
Print Name: IA 0 n i C(A C?)Jo°le (..t^.-
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 4, l6 ByKy
Refund Processed: Date /1/ /9- By . ' Invoice Processed: Date By
Permit Canceled: Date //L//A, By 'arcel Tag Added: Date By
I:\Building\Forms\RegPennitAction_ 231 oc