Permit Support Document (27) 2018/01 /24 12:33:08 2 /3
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City of Tigard ' COMMUNITY DEVELOPMENT DEPARTMENT ,,1AN 2 4 2 18
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Request Permit Action ` }`
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439•www.tigard-or.gov
TO: CITY OF TIGARD / n Iry,,,-,
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Building Division Services Supervisor " g
13125 SW Hall Blvd.,Tigard,OR 97223
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Phone: 503.718.2430 Bax: 503.598.1960 www.tigard-or.gov 42 /'
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check one)
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REFUND OR Name: ADT IIC
INVOICE TO: (Rosiness nr Individual) .
Mailing Address: 7989 SW CIRRUS DR
City/State/Zip: BI AVERTON, OR 97008
Phone No,: 5034697241
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
(1 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below),
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: ELR201.7-00156
Site Address or Parcel#: 9075 SW BURNHAM S'I'
Project Name: TIGARD ALIGNMENT&AUTO REPAIR _
Subdivision Name: Lot#:
EXPLANATION: EXSISTING ALARM SYSTEM HAS FIRE-CANNOT DO INSTALL
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k.Signature: -�- .;;; ‹:,..2, Ir"(} Ni c.-../) y,-,-•„,.,
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LORI MCAIURPHY
Print Name:
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Round Policy G+ r C Z �0 ,,,______L-,iff
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected. 'City b. 7, :;2-e) l e,r,PcJ
b) not more than 80%of the land use application fee when an trpphcation is withdrawn or canceled before any review effort has been upended.
c) not more than 80%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.
c) not more than 80%of the buildingpertnit fee Inc issued permits prior In any inspection rcaucsts.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte toSys admin: Date By Rte to Bid:Adman: Date ' - B�yjr
Refund Processed: Date 023 /, By' 47/ Invoice Processed: Date By
Permit Canceled: Date e9-AS7/,1- By Pamet T Added: Date By
Receipt# j Date Method Amount$
l:\Building\porins\ReyPerinitAetion.doc Rev 05/2.512012
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TIGARD
City of Tigard
March 1, 2018
ADT LLC
Attn: Lori McMurphy
7989 SW Cirrus Dr.
Beaverton, OR 97008
Re: Permit No. RT,R2017-00156
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9075 SW Burnham St.
Project Name: Tigard Alignment&Auto Repair
Job No.: N/A
Refund Method: ® Check#227675 in the amount of$67.20.
0 Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
0 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,
✓ �, -
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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