Permit Support Document (41) RECEIVE')
City of Tigard 0 COMMUNITY DEVELOPMENT DEPARTMENT MAY 7 2018
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' 2 equest for Permit Action CITY OF TIGARD
TIGARD 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www.tigaAWING MRON
TO: CITY OF TIGARD
VOID
Building Division
13125 SW Hall 131vd,Tigard,OR 97223 47.,1- r— 5E02r--
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermitsd- r.goAv
FROM: 0 Owner 0 Applicant ti Contractor 0 City Staff
Check(1)one
REFUND OR Name.
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INVOICE TO:
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Phone No.: 7 -?). ,S) -Cc1.. fl Ln-)
PLE• SE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
IC/ CANCEL/VOID PERMIT APPLICATION.
IP; ' FUND PERMIT FEES (attach copy of original receipt and provide explanation below).
al INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
n REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: taC. 2t)n-,,()0Q,
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Site Address or Parcel#: \-j 0 vi,_) LA.A.i W\A C .__
Project Name:
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Subdivision Name: 0 Ilk A bk..!'. ') tk,ti, Aa Lot 4 \q,
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Eq)LANATION: ,_,_,,,, „ iLv_v_v__Ck
Signature: \
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' lei Date: 1 c-
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Print Name: 'w -I CA()' Le , Oct* tr's
Refund Policy
I. 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 34 weeks for processing refund request& .
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FOR OFFICI, USE ONLY
Route to Sys Admin: Date By Route to Records: Date p,A 22,/,c; By if
Refund Processed: Date-J/4/7i,- By ; Invoice Processed: Date By
Permit Canceled: Date -1/41-/./a- By ,f- Parcel Tag Added: Date By
I:\BuildineFonns\ReqPermitAction 09'231 4.doc
IIIN
TIGARD
City of Tigard
6/1/2018
Bruton Comfort Control
12720 SW Allen Blvd.
Beaverton, OR 97005
Re: Permit No. MEC2018-00326
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15270 SW Hudson Ave.
Project Name: Welk
Job No.: N/A
Refund Method: ® Check#228640 in the amount of$80.64.
0 Credit card "return" receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ 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,
-orf�-
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