Permit Support Document (2) RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 2 3 2019
Request for Permit Action CITY OF IIGARD
r I K D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigardBUILDING DIVISION-ongov
TO: CITY OF TIGARD V 0 I D
Building Division f/g//V ..atifiA"
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: 0 Owner 0 Applicant El Contractor 0 City Staff
Check(V)one
REFUND OR Name:
INVOICE TO: (Business tar individual) Garner Electric Washington LLC
Mailing Address: 402 Valley Ave NW Ste 106
City/State/Zip: Puyallup,WA 98371
Phone No.: 253-872-6051
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
;110 CANCEL/VOID PERMIT APPLICATION.
E] REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
Ei INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: ELC2019-00479
Site Address or Parcel#:
Project Name: Willowbrook
Subdivision Name: Lot#: 16
EXPLANATION: Garner did not need to pull separate electrical permits as they are issued under a
combination permit(MST)when the aeneral contractor or developer obtains the permits.
Signature: .-.- ' (C-----r:ert 42,l't ", Date: 7/23/2019
Print Name: Alicia Gentele
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 cape-tided.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2„811 refunds will be returned to the original payer in the Ginn of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests. .00,"7'(00 , 7 O — 54 FV, . , ::--
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FOR OFFICE USE ONLY
Route to Sys Admin: Date-4.k .k kCk By __\-\--- Route to Records: Date .' :1 7 ;1-/ By f r
Refund Processed: Date ed- / Byaki Invoice Processed: Date By
Permit Canceled: Date /9- e2 By Parcel Parcel Tag Added: Date By
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