Permit Support Document (2) RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 2 3 2019
- CITY OF fIGARD
• .2. . Request for Permit Action BUILDING DIVISION
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division V (2 I
13125 SW Hall Blvd.,Tigard,OR 97223 eY.,- (9 d
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@ • rd-or.gov
FROM: Owner Applicant El Contractor 0 City Staff
Check(V)One
REFUND OR Name:
INVOICE TO: (Business or Indnidual) 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):
gCANCEL/VOID PERMIT APPLICATION.
El REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: ELC2019-00378
Site Address or Parcel#: --r) al96/4162— S 7-
Project Name: Willowbrook
Subdivision Name: Lot #: 1
EXPLANATION: Garner did not need to pull separate electrical permits as they are issued under a
combination permit(MST)when the general contractor or developer obtains the permits.
(77:7 - -
Signature: /COL (1,Pt h""-"" Date: 7/23/2019
Print Name: Alicia Gentele
Refund Poitcy
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• Not more than 800A,of the application or plan review fee when an application is withdrawn or canceled before review effort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.
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FOR OFFICE USE ONLY
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Permit Canceled: Date effS.-/, By ..11111Ws. Parcel Tag Added: Date By
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