SGN2014-00082 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 1 ,
71
. " Request Permit Action 7/iy�,� �
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TIGARD 13125 SW Hall Blvd. • Tigard. Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor
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 Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® 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).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: SGN2014-00082
Site Address or Parcel#: 7148 SW Gonzaga
Project Name: The Adrienne
Subdivision Name: Lot#:
EXPLANATION: Based on the error message, I did not realize the permits had been
created so I started over. These permits are not needed because the signs were issued through
permits SGN2014-00087 _
Signature: C;PN , C.GtiI'' Date: 7/1/14
Cheryl Caines
Print Name:
Refund Policy
1. The Community Development 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b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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.
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original paver in the form of a check. Pk a e allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Rte to S s Admin: Date B' itte t0
-- \dmut: Date?®® Z f�i%'
Refund Processed: Date V " By ..7 Invoice Processed: Date By
Permit Canceled: Date 7/Zy//if By . -• Parcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Building\Forms\RegPermitAction_062614.doc