Permit Support Document (37) ,. . RE CE WE
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
MAY 1 4 2018
Nag Request for Permit Action ��y
r i c A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •ww�w.tigard-or. STY OF TIGARD
B ILDING DI
VISIOX
TO: CITY OF TIGARD V0
Building Division 4.-...-'
13125 SW Hall Blvd.,Tigard,OR 97223 57( /t
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
❑ Owner ❑ Applicant Contractor ❑ City Staff
Check ✓ one
REFUND OR Name: j f
INVOICE TO: (Business or Individual) A.' fl\ ,`je,,CV i re
Mailing Address: 15669 AJE }'R.e,i C) -Re
City/State/Zip: A b l,/ , L,/,4 986 c /
Phone No.: 360 - D63- 500
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
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).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: /V\E C c)1 j - en 2B
Site Address or Parcel#: 1 SC, SCS SLA) Ot(j Orclia-eci Pl.
Project Name: ` )ecavi \Aiale.S
Subdivision Name: SirY"ei ;p.Id /Jd, T Lot#: 1 LI '
EXPLANATION: ,tis -orrle,�" 15 i'1C! latter �oinn 11Cu )5
(,;-��) -flit_ iwc . �.J
Signature: 44474- 0,,,,-4— Date: 5//-1/1e)
Print Name: ge,beer abain Cy". an
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. 9 el, ,C)Z) 7 ) c"V -- AP. c
—.
Route to Sys Admin: Date c- By Route to Records: Date cV c�.2 1? By
Refund Processed: Date s/(7/ By/ ( Invoice Processed: Date By
Permit Canceled: Date .�7 'J By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_ 231 .doc
a
.III
TIGARD
City of Tigard
6/1/2018
J &M Contractor Services
15604 NE Reid Rd
Amboy,WA 98601
Re: Permit No. MEC2018-00282
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15650 SW Old Orchard P1
Project Name: Wales
Job No.: N/A
Refund Method: /1 Check#228652 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.
0 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,
'<39.''''5;4<e,z6)-7--
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
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