SLR2020-00005 42,
V u D RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT SEP 0 2 2020
Request for Permit Action CITY OF TIGARD
BUILDING DIVISION
> 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) Monica Bilodeau
Mailing Address: 13125 SW Hall Blvd.
City/State/Zip: Tigard, OR 97223
Phone No.: 503.718.2127
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (•/):
❑X CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: CUP2020-00002 and SLR2020-00005
Site Address or Parcel#:
Project Name: Fanno Creek Trail
Subdivision Name: Lot#:
EXPLANATION: Cases created in Error. Void case. No refund requested as no fees were paid.
.SET; c-we 20 2n -0000 1 fs S L-12- ZCI .2-6 -- 0000 /
Signature: Monica Bilodeau Date: 9/2/20
Print Name: Monica Bilodeau
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date y/� a-� By I' if;
Refund Processed: Date ////A- By �(O Invoice Processed: Date By
Permit Canceled: Date 9/2/Z0 By / Parcel Tag Added: Date By
I:\Building\Forms\RegPennitAction_42055 8.doc