Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit Support Document (17)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JAN20 M Request for Permit Action Ga . ,u i, -11, TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.ti a t i-; DIVISION TO: CITY OF TIGARD 0- 1 !,) Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 / //c Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business orIndividual) AI.pHa v vrni�1tr s�visc-es Mailing Address: /IQ�Q�/ /tI`tki SAO/, Ji/ . /eV City/State/Zip: geeVe/'7' -1 , /Z 9'70e S` Phone No.: 28'- 731"1- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): g� CANCEL/VOID PERMIT APPLICATION. 0.1 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#: PIN 20!l-DO/4-d//O 5 Site Address or Parcel#: H 35 J ) .6/1d, - P.GrCe/ '2 S,//A,404100 Project Name: A_9/1/" TYWJ CI7v.d M7/ Subdivision Name: 6yee csiAle rd &{vK. ✓< Lot#: 3(.49 EXPLANATION: vna_b/e per„ )-FQ)-0,7 book* dvP -1--o 9i'z)Ynd CO)7di1/2.6v)s. Signature: Date: //fly/d' Print Name: , De- Le-,n 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. 7 e, s.© — Se/ Z; Q �V ch 70 -- _.� - /1 7 y Oe/ -& /6 . FOR OFFICE USE ONLY _ Route to Sys Admin: Date By Route to Records: Date �,- /9 By 1:j•' Refund Processed: Datc .2/e //I By Invoice Processed: Date By Permit Canceled: Date pl //,f.- By Parcel Tag Added: Date By I:\Building\Forms\RegPernvtAction_0§2314. oc III II TIGARD City of Tigard , March 1, 2018 Alpha Engineering Services Inc. Attn: Ali De Leon 11080 SW Allen Blvd., Suite 100 Beaverton, OR 97005 Re: Permit No. PLM2018-00005 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 14435 SW Hall Blvd. Project Name: Equity Trust Company Job No.: N/A Refund Method: ® Check#227677 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, "c:(a-i2,yerze.9_,Lrz 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