MIS2004-00020 /t1 / 32OOY - OOOZO
WIT}+ DFAWN
Case Activity Listing 1/6/2005
g 12:12:17PM
TIDEMARK Case #: NIIS2004-00020
COMPUTER SYSTEMS. INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
MIS1020 Application received 12/6/2004 None DONE CAC 12/6/2004
CAC
•
MIS1030 Case created 12/6/2004 None DONE CAC 12/6/2004
CAC
MIS]090 Application 12/21/2004 None WDRN GBP PLL 1/6/2005 Applicant officially withdrew their
withdrawn PLL application on 12/21/04. Application
withdrawn for lack of two lots for
LLA.He will resubmit for a MLP.
•
Page 1 of 1 CaseActivity..rpt
CITY OF TIGARD
OREGON
January 6, 2005
Ryan Paddock
4340 SE Johnson Creek Blvd.
Milwaukie, OR 97222
Re: Permit No. MIS2004-00020
Dear Mr. Paddock:
The City of Tigard has canceled the above referenced permit and enclose a refund for the
following:
Site Address: 9865 SW Johnson St.
Project Name: Paddock
Job No.: N/A
Refund: Check#035409 in the amount of$383.00.
Credit card"return"receipt in the amount of$N/A.
Notes: Refund 100% of application fee per applicant's request and resubmitted under a
pre-application case.
If you have any questions please contact me at(503) 718-2430.
Sincerely,
Dianna Howse
Permit Specialist
Enc.
13125 SW Haliall 4 x aS Ng, Q 43244171 TDD (503) 684-2772
■-■1 t mamrsla, LI t la Li IN 0 3 5 4 0 9
• Vendor: Ryan Paddock Check Date: 12/29/2004
- Vendor No: PER00234 Vendor Acct No: Check Amount: 5383.00
Invoice Number Date Description Invoice Amount
Refund-Permit 12/28/2004 T04-5249/MIS04-00020 383.00
•
„ - - .%;r,rr7rgyirtyroT-4SrAir,:zirk:.jriTtrr,r4-rfd0..WErCr#11:rroi,'(iriTOTUZI-C T'r7-:• 4430 .5ofiqt. 404111TOCRA ,471r. 4:41110,
CITY OF TIGARD BANK OF AMERICA 0 3 5 4 0 9
13125 S.W. Hall Blvd. PORTLAND OREGON 972E —3230
Tigard. OR 97223
1503) 639-4171 •
CITY OF TIGARD Fed. I.D. 93-0503940 VOID AFTER 180 DAYS
Pay: *** Three hundred eighty-three dollars and Zero cents
Date Amount
12/29/2004 $383.00
•
To the order of:
Ryan Paddock
4340 SE Johnson Creek Blvd
Milwaukie, OR 97222 :.p
•
• •
City of Tigard
�.�j411i'► Check Refund Request
w�
City of Tigard
This form is used for refund requests of permit application fees paid by check transactions only.
Receipts, documentation and applicant's request for refund, if applicable, must be attached to
this form. Approved request (original and one copy) due Monday 5:00 PM to Accounts
Payable for checks by Friday. A/P will route a copy of the request to the Tidemark System
Administrator for refund of case fees.
VENDOR NO.: DATE: December 27, 2004
PAYABLE TO: Ryan Paddock REQUESTED BY: Dianna Howse
4340 SE Johnson Crk Blvd.
Milwaukie, OR 97222
TRANSACTION Receipt#: 2004-5249 Case #: MIS2004-00020
INFORMATION: Receipt Date: 12/6/04 Site Address: 9865 SW Johnson St.
Check#: 1120 Project Name: Paddock
EXPLANATION: Refund 100%of application fee per applicant's request and resubmittal under a
pre-application case (see Gary Pagenstecher).
EXPENDITURES:
Fee Description From Receipt ,Revenue Account No. • • $.Amount
_
Example: [BUILD) Permit Fee ° •Example: 245-0000-432000
[LANDUS] Lot Line Adjustment 100-0000-438000 $383.00
TOTAL REFUND: $383.00
APPROVALS:
OF UNDER $50) Section Manager/Professional Staff
(IF UNDER $2500) Division Manager ��. ,`! .Xt.
(IF UNDER $7500) Department Manager
(IF UNDER$25000) City Manager
(IF OVER$25000) Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY .
I Case Refund Processed: _ Date: j /r 7/c'f By:
i:\Building\Refunds\RefundCheckRequest.doc 05/04
•
RECCE win)
December 21, 2004 R 200
CITY OFTIGARD
P�pNftlli`I�' NGI VEERING
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
To: City of Tigard
From: Ryan Paddock
Re: Refund Request, 9865 SW Johnson
I am requesting a refund for the lot line adjustment fee of$383.00 which was paid on December
6, 2004. I have withdrawn the lot line adjustment application and have submitted a"pre-
application conference request"application and plan to proceed with a partition instead of a lot
line adjustment.
Please call if further clarification is required(work phone: 503-228-3848).
Cordially,
Ryan Paddock
C�
Li 3c t0 SE C, ES/CA
(1A c 1 c. ,t. 1 o(L 72z�