TRE2020-00052 Va ' J
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT SO,/ 40
Request for Permit Action
I ,A r I 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits®tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor Q City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/ ID PERMIT APPLICATION.
PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FF.FS DUE (attach case fee schedule and provide explanation below).
Perrtut#: TRE2020-00052
Site Address or Parcel#: 7477 SW Tech Center
Project Name:
Subdivision Name: Lot#:
EXPLANATION: Duplicate of TRE2020-00053
Signature: ' L� //j (� „rb Date: 11/16/2020
Print Name: Agnes ndor
Rcfund 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Adtnin: Date By Route to Records: Date / By ,/Q
Refund Processed: Date,J/ By Invoice Processed: Date By
Permit Canceled: Date .3/i/yi By� Parcel Tag Added: Date By
I:\Building\Forms\RegPemitAction_120 18.doc