Permit Support Document RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
• MAY 14 2020
Request for Permit Action CITY pF TiGARD
TIGARD, 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • ww .v.tigard-� 1�PING DIVISION
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@rigard-or.gov
FROM: ❑ Owner 0 Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (ilnsinessorIndividual) David Weekley Homes
Mailing Address: 1905 NW 169th Place Suite 102
City/State/Zip: Beaverton
Phone No.: 503-213-4415
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
7 CANCP.T /VOID PERMIT APPLICATION.
U REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedul epl 'on below).
Permit#: MS.T-202-0a124 Sv - DC70 7�
Site Address or Parcel#: 10894 SW Teal Crest PI
Project Name:
Subdivision Name: Summerbrook Lot#: 9
EXPLANATION: ase cancel builidng permit applicaiton- new plan to be built on site
Signature: Date: 5 Itqlz.,0
Print Name: 'ch ch edler
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
"2D S - / . L=V, -e )
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date Y'
Refund Processed: Date .4 4 By L) Invoice Processed: Date ' B
Permit Canceled: Datelo/$ Bye/0 Parcel Tag Added: Date By
I:\Building\Forms\RegPernutAcrinn_20 S.doc