Correspondence C Community Development r•ECEIVED
Request for Permit Action
TIGARD'
MAY 2
TO: CITY OF TIGARD CITY OF TIGARD
Building Division Services Coordinator BUILDING DIVISION
13125 S \V Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor r>teCity Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
V n Mailing Address:
{ U 11 Cit /State /Zip:
4:79/ar
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available). /t/0 2E 4 S o7e
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). 7/1 tJO L % �
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: E 9\002 " oo / `t
Site Address or Parcel #: 1 1 70 S L 2,J i .) E.
Project Name: M 11 (2 to
Subdivision Name: ,�,9 Lot #:
EXPLANATION: R I S r t r kEPLA- ` o1 g~ GYS A ff?
LQ9Lil r J `TJ c�� L t F F £ 2� 0,00 -c QT •
Signature: AAA__ • Date: 5-/A,4
Print Name: ► p g,i 2. ( bil -H, i
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more than 80% of the building permit fcc for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
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Rte to S's Admin: Date 5 Ao p$ EMMA Rte to Bld: Admin: Date 4/Vo, B
Refund Processed: Date ,V /,9 By Invoice Processed: Date By
Permit Canceled: Date 4/9/D,f p Parcel Tag Added: Date By
Receipt # Date ` Method Amount $
1:A Building \ Forms \RegPermitAction.doc Rev (17/26/O7
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C T \ Or
Rel
1108 SE DOGWOOD LANE
OAK GROVE, OREGON 97267
P H . 5 0 3 . 9 3 6 . 5 2 2 6
FAX 5 0 3 7 8 6 . 6 0 0 5
( ( B 8 5 8 9 6
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
City of Tigard Philip eecher ht1-11 0— Dvtheinka- 0 4'02- M VI"
DEPT: DATE:
Electrical Permi 5. ,.Q
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
• 503.598-1960 1
PHONE NUMB1+R: OUR PHONE NUMBER:
503-6394171 (503)786-6005 Office/ (503) 936-5226 Phihp
RE: OUR FAX NUMBER:
Permit Transfer (503)786-6005
°URGENT 0 OR RIATTP,w 0 PLF:AsE commENT 0 pLEASE REPLY 0 pLEAsE RtCYCI,F.
Nui Es/commENTs-
Re: Permit # EL 2008 00 i It 4
Site Address: 117 8 SW Warner Ave — Mirage Mini Storage
P.B. Electric will not be :-.omplcicing the electrical work for this job address. Please transfer to new
electrical contractOr. P ase contact EGCI for information at (503) 638-0170.
Thank you.
Of all-3 cP I)
T000 SO 09 99 L. £ 02 XVd ZO:60 800Z/90/20