Permit Support Document (2) RECEIVED
. , City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 2 3 2019
. 4 CITY OF fIGARD
. . ..
Request for Permit Action
II
BUILDING DIVISION!
T 1(TA R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD V 0 1 0
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223 O /.f <1#674—
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: El Owner 0 Applicant 0 Contractor 0 City Staff
Check(I)one
REFUND OR Name:
INVOICE TO: (Business or 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 e():
rl CANCEL/VOID PERMIT APPLICATION.
0 REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
ri INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: ELC2019-00311
Site Address or Parcel #: h 330 .51.,3 C--,M110-4.- r 7--
Project Name: Willowbrook
Subdivision Name: Lot#: 2
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.
Signature: -14(1 Ci. ( 7)0 IA 0 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 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
Route to Sys Admire Date-N-tktck By ...1-- Route to Records: Date , .17 ..1-/ B' V
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Refund Processed: Date „pp/ q B•01 Invoice Processed: Date By
Permit Canceled: Date Fp- 1,F %Ova' Parcel Tag Added: Date By
I:\Building\Forms\ResiPermitAetion_1205l ,doe