MMD2018-00013 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT•
•
Request for Permit Action1111
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TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.go
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: n Owner ❑ Applicant ❑ Contractor ® City Staff
Check(V)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
r ® CA /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 #: MMD2018-00013
Site Address or Parcel #: 10965 SW Errol Street
Project Name: Porter Lane,LLC
Subdivision Name: N/A Lot #: N/A
EXPLANATION: Staff accidentally created this as MMD case,when it should be UFR case.
Please void MMD2018-00013 and transfer permit fees to UFR2018-00002.
Date: 4/16/18
Signature: --t- f
Print Name: Lina Smith
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 �2 By '!ralr
. ,0 aigi.d.Processed: Date 4:;./7 /r By 44 Invoice Processed: Date By
Permit Canceled: Date /7 �f- By t: r Parcel Tag Added: Date _By
I:\Building\Forms\RegPermitAction_ 92 14.doc