Permit Support Document (36) RECEIVE!)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAY 2 2018
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Request for Permit Action CITY OF TIGARD
_f:i; 13125 SW Hall Blvd.•Tigard,Oregon 97223* 503-718-2439 •v=zaisittalaING DIVISION
TO: CITY OF TIGARD
Building Division 78 //f
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Far 503-598-1960 TigardBuildingPermits®tigard-or.gov
FROM: ❑ Owner ❑ AppIicant Contractor 0 City Staff
check(v)one
REFUND OR Name: 1 f j�
INVOICE TO: (B¢arteys or TnJividual) ` 'ft1/d /Z'1 d'1l//�j G (/
Address: 3 5(d 1j t� ) '� �' Ot. )t
Nlatlingrj
City/State/Zip: -Ig )/G.✓ re
Phone No.: 563- 'A 33`3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
E CANCEL/VOID PERMIT APPLICATION.
aREFUND 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#: I \�C7 ! r ,;'�jp
Site Address or Parcel#: j 01,1:At. Crrt,ve. �e r r
Project Name:
Subdivision Name: . yG f .re-ace, no Lot#: �J
EXPLANATION: C ositoThe( Ib i-D CIM67 Gy> UJ1*\ a C ( (6c--- ars
Signature: ! ' Date: � j 2 >1 1
Print Name: 1-244-v-ek.
Refund Policy
1. The dty's Community Development Director,Building Official or City Engineer may authorize the refund of.
• Any foe which was erroneously paid or colloctod.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 appheation Or permit fee for issued prrmirs prior to any inspection requests.
2 All refunds will be returned to the original payer in the form of a check via CJS postal service. G
3- Please allow 3-4 weeks for processing refund requests. 90 Crz) _ 22 t cr t /p r cre
FOR OFFICE USE ONLY
Route to Sys Admin_ Date B• - Route to Records: Date a /9 13, ,t;
Refund Processed: _ Date a-a- Invoice Processed: Date By
Permit Canceled: Date4/,k- By, "' 'Parcel Tag Added: Date By
l:\Building\Forms\Ite4pcmitAc ( 233142oe
100/Z00 'd 960L# N310HU9 Z00699EE09 90:60 810Z/Z0/90
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TIGARD
City of Tigard
6/1/2018
Garoken Energy Co.
3565 SW 182nd Ave.
Beaverton, OR 97003
Re: Permit No. MEC2018-00256
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13232 SW Apple Grove Terr
Project Name: River Terrace Northwest
Job No.: N/A
Refund Method: ® Check#228649 in the amount of$80.64.
❑ Credit card "return"receipt in the amount of$
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 customer cancelled job. Refund 80% of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
9/74-Arr"-C--
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