Permit Support Document (67) IN
,1
TIGARD
City of Tigard
September 17, 2018
A Team Heating
Attn: Sadie Gulliksen
1635 Candlewood Dr NE
Salem, OR 97301
Re: Permit No. MEC2018-00646
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14103 SW Fanno Creek P1
Project Name: McDaniel
Job No.: N/A
Refund Method: ® Check#229716 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 the job. 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
IIp City of Tigard
g
T►c A R o Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: A Team Heating DATE: 9/10/2018
1635 Candlewood Dr NE
Salem, OR 97301 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 419017 Case#: MEC2018-00646
Date: 8/20/2018 Address/Parcel: 14103 SW Fanno Creek P1
Pay Method: CreditCard Project Name: McDaniel
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees.
EPTEI-Ca
a e .1-
a 4T.-W,,,� ee l# ; , � s -' �����$ ��lg�,r9 r
Mechanical Permit 230-0000-43102 $72.00
12%State Surchar.e 100-0000-24001 $8.64
TOTAL REFUND: $80.64
APPROVALS: SIG URES/DATE:
If under$5,000 Professional Staff -47-4j— e--_
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
Case Refund Processed: Date: c/7jy�i y By: 4'
,y r
I:\Building\Refunds\RefundRequest.doc x 09/01/2010