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Permit 11/20/2008 15:02 FAX 360 737 9648 T &L Communications lj0001 /0001 . . Community DevelopCEIV ED TIGARD Request for Permit Acti NOV 0 CITY OF TIGARD TO: CITY OF TIGARD BUILDING DIVISION Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or,gov FROM: ❑ Owner © Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Iruiividual) T &L Communications, Inc V ®I D Mailing Address: P.O. Box 87387 • City /State /Zip: Vancouver, WA 98687 ,, /Mio1 Phone No.: 360 -737 -9725 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): © CANCEL PERMIT APPLICATION. ® REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: BUP 008 -00327 and 008 -00277 - R � " Er= 5 4? e_TEt F 47----- Site Address or Parcel #: . SW Washington Square Road, Portland, OR 97223 Project Name: Sanrio Subdivision Name: • Washington Square Lot #: EXPLANATION: Fire alarm is no longer required at this location Signature: g. „) Date: 11/20/2008 Print Name: Larry Bushaw Refund Pol.ev 1. The Director or Building Official may authorize the refund o@ a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fcc when an application is withdrawn or canceled before any review effort has been expended.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. e) not more than 80% of the building pc,.uit fee for issued permits poor 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. Rte to Sys Admin: Date By Rte to Bldg Admin: Date /,z/fP O By Refund Processed: Date / / / 2 J By . €_I nvoice Processed: Date / By / 2 Permit Canceled: Date i By arcel Tag Added; Date By Receipt # Q,p jirt Date / 9/O Method' e fc_ Amount $ t:\ Building \Forms \RegPermitAction.doe ev 07/26/07