Permit Support Document (25) •
City of Tigtardf • COMMUNITYr �tDEVELOPNT DEPARTMENT E L)L .
o�
Re uesour e'e ,aN
q rxactMEor�
T,'s_;A.R I) 13125 SW Hall Blvd. •Ti• gard,Oregon 97223 . 503-718-2439 ••www.ti at y Vii'- t ,.1'=� .)
UIQ. lr.`.nloo;('�`
TO:. CITY OF TIGARD VOID
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223 ,7?�,.z �/�
Phone: 503-718-2439 Fax: 503-598-1960 .TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner . Nt Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) g i ACE: to 44 EL c ktc L
Mailing Address:. 2904 TV.ft t es e-D S
City/State/Zip: 4LLrij 1 ok, 1'13 27._
Phone No,: S41.ca lo. OSQL(
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
ig CANCEL/VOID PERMIT APPLICATION.
S. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR PEES DUE(attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: • ELC,9,011 - 00%
Site Address or Parcel#: 11'11$ Se,wJ summEk GsiE.Sl-- Q ft
Project Name: 14%J NTE&• 2(e 1 ZU
Subdivision Name: Lot#:
EXPLANATION: C'KS'1-a+mcEl(6; ok'K Ncet.t..E_q ?1VSfc_, rPtEAcZ.
Signature: Date: 1/(1/1 8'
Print Name: E+attoJ tg
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. /5, 4 9
7e. y% g.v2 . /-›
'., y/ -- 7, 53 — / 1;
?7.1-is 7e , �f / 7,5.7
Route to Sys Admin: Date By Route to Records: Date ., , _Lei By
Refund Processed: Date,�iJo2_3`/ By Invoice Processed: _
�2 „ Date By
Permit Canceled; Date / 23/ By Parcel Tag Added: Date By
I:\Building\Forms\RegPcs tAcron_o 2314, oc
IIIa
p
TIGARD
City of Tigard
March 1, 2018
Rite Way Electric
Attn: Emerson Smoker
2904 Three Lakes Rd SE
Albany, OR 97322
Re: Permit No. ELC2017-00507
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11715 SW Summer Crest Dr
Project Name: Hunter
Job No.: N/A
Refund Method: ►1 Check#227757 in the amount of$70.28.
❑ Credit card "return"receipt in the amount of$
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,
AO, i
Dianna Howse
Building Division Services Supervisor
Enc.
i
I
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov