Permit Support Document (32) r ,
City of Tigard • CONINICINITY Dl?\ I.I.OPNII:N I DrP.1Rr:\IEN l RECEIVED
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Request for Permit Action ' 102O199
'TSAR,D'. 13125 SW ITall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • w,ww.tigard-t T�6OF TIGARD
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TO: CITY OF TIGARDV 0 Irif
Building Division �` ��--~�
13125 Six'Fall Blvd.,Tigard, OR 97223 /41/1/9
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Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerinit @tigard-or.gov
FROM: fl OwnerApplicant I Contractor I I City Staff
check(✓)otic t
REFUND OR Name:
INVOICE TO: niu.sins, l individual) ' ' 4�1 t VVYl Vpl W.0 to�C .
Mailing address: ' cA(A��� j�tl 11�' ' Y,('� � �Ski ' 61
City/State/Zip: j\ (\ 3
Phone No.: _ -50"l „
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).
Permit#: 9( VA(ZA- OcG9\
Site Address or Parcel #: 'L_ {, I. '' )0' ,\,)\Q chi,Jf-\-
Project Name:
Subdivision Name: Lot#:
EXPLANATION: SS ^(\O Y e u mid
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Signature: ` , `2 �,(r ti 1l � Date: \V \\
Print Name: k.. I fs L....
Refund Pnliet
I. The city's Community Development Director,Building Official or City l'.nfnnect may authorize the refund of
• ,1n\fee which was erroneously paid or collected.
• Not inure than 80"„of the application or plan review fee when an application is withdrawn or canceled before review effort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°0 of the application or permit fee for issued permits prior to any inspection requests.
2. .All refunds will be returned to the ori Ana]payer in the form of a check via I S postal service.
3. Please allow 3-4 weeks for processing refund requests. > _ �.�L7
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FOR OFFICE USE ONLY
Route to Sys Admin: Date ft By j Route to Records: Date 2; /7 Bp4.•••. �
Refund Processed: Date t By A-"4 Invoice Processed: Date By
Permit Canceled: Date //,/, , By If'.I Parcel Tag Added: Date By
L\Building\Forms ite 1 nit.Acoon 11 518.d
-
TIGARD
City of Tigard
January 24,2019
Western Plumbing, Inc.
9460 SW Tigard St., Suite 101
Tigard, OR 97223
Re: Permit No. PLM2018-00559
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14230 SW Vista View Ct
Project Name: Kumm
Job No.: N/A
Refund Method: ® Check#231067 in the amount of$64.96.
❑ Credit card"return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TfGAR1)
Project Name: Vista View Court
Site Address: 14230 SW VISTA VIEW CT
Receipt Number: 421252 - 01/25/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2018-00559 $-64.96
Total: $-64.96
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 231067 DHOWSE 01/25/2019 $-64.96
Payor: Western Plumbing, Inc.
Total Payments: $-64.96
Balance Due: $64.96
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CITY OF TIGARD14 RECEIPT
a~ , 13125 SW Hall Blvd.,Tigard OR 97223
- 503.639.4171
TIGAP D
Project Name: Vista View Court
Site Address: 14230 SW VISTA VIEW CT
Receipt Number: 420770 - 12/13/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2018-00559 Water Service 230-0000-43101 $62.54
PLM2018-00559 12% State Surcharge-Plumbing 100-0000-24001 $8.70
PLM2018-00559 Minimum Fee Adjustment-Plumbing 230-0000-43101 $9.96
Total: $81.20
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 113151 PUBLICUSER107 12/13/2018 $81.20
Payor: William Dovers
Total Payments: $81.20
Balance Due: $0.00
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