Permit Support Document (39) RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
14
ill
APR 2 b 2018
s Request for Permit Action CITY OF rIGARD
TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigart b PING DIVISION
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223 S Ae/r Wig'I
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: n Owner I/Applicant (l Contractor n City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) c y ~
Mailing Address: `0`11 5 c .c.) \\, 20
City/State/Zip: ° ._-'-0 \€ C).i.2_ c bi ,' `i 3
Phone No.: L..)&' 3__ 35-t-77--t..
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
El/ 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).
(l REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: t LC/ .:°l ° t:-P--t4
Site Address or Parcel #: (15- 6- @ ua ct t J,,,,6-re
Project Name: —1--e- \a
Subdivision Name: Lot #:
EXPLANATION: . c ' iv' ,, : { :red : z„. , (, ' e :=='f '
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Signature:Si
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Print Name: -Tie.l✓"i • I'
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 he 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.
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FOR OFFICE USE ONLY
ttt to Sys Admin:- Date . I By Route to Records: Date " �le- Pr _i
Processed: Dare Mr', B Invoice Processed: Date By R
Refund - I2 I
C Permit Canceled: Date .-..c///e/c B' r� Parcel Tag Addeel Date. By
h Ran ding\Porins\RegPennitAction_05.314.ikc
111
TIGARD
City of Tigard
6/1/2018
Mister Sparky of Beaverton
6775 SW 111th Ave, Suite 20
Beaverton, OR 97008
Re: Permit No. ELC2018-00243
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9585 SW Washington Square Rd
Project Name: Tesla
Job No.: N/A
Refund Method: ® Check#228660 in the amount of$598.35.
0 Credit card"return"receipt in the amount of$
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 scope of work required plan review and the job
was awarded to another contractor. 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