Correspondence (10) • CITY OF TIGARD
Buildin g Division
TIGARD 13125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171
INVOICE
TO: Bradlee Distributors, Inc. Customer ID: C08-0005
6777 SW Bonita Rd., #100 Invoice No.: INV2008-00021
Tigard, OR 97224 Invoice Date: 12/15/08
Attn: Mitch Jensen Date Due: Upon Receipt
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
BUP2008-00193 6777 SW Bonita Rd.,#100 Bradlee Distributors
Plan review balance due: $63.45
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Invoice Total: $63.45
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: BUP2008-00193 Customer ID: C08-0005
Site Address: 6777 SW Bonita Rd., #100 Invoice No.: INV2008-00021
Project: Bradlee Distributors Invoice Date: 12/15/08
Date Due: Upon Receipt
Invoice Total: $63.45
Amount Paid: $
Office Note: Forward copy of receipt to Dianna Howse for invoice file.
Please mail payment to:
City of Tigard, Building Division
13125 SW Hall Blvd.
Tigard, OR 97223
Attn: Dianna Howse
I:\Building\Accounting\Invoice.doc 04/06
12/15/2008
111 CITY OF TIGARD Fees Associated With 8:36:17AM
■ 13125 SW Hall Blvd. Case#: BUP2008-00193
T l G A R D Tigard,OR 97223 503.639.4171
Fee Start End
Revenue Created
By Date Amount Due
Type Date Date Dept Description Account Number
PLCK 1/1/1990 12/31/2020 [BUPPLN]Pln Rv 245-0000-433000 BLD 6/6/2008 14.36 0.00
FIRE 1/1/1990 12/31/2020 [FLS]FLS Pln Rv 245-0000-433020 BLD 6/6/2008 47.88 0.00
PRMT 1/1/1990 12/31/2020 [BUILD]Permit Fee 245-0000-432000 DAN 6/12/2008 119.70 119.70
SUR1 12/31/2007 12/31/2020 [TAX] 12%State Surcharge 100-0000-207020 DAN 6/12/2008 14.36 14.36
PLCK 1/1/1990 12/31/2020 [BUPPLN] Pln Rv 245-0000-433000 DAN 6/12/2008 63.45 63.45
Total Due: $197.51
Page 1 of 1 CaseFees..rpt
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CITY OF TIGARD 1/12/2009
111111 i 13125 SW Hall Blvd. 2:57:28PM
Tigard,OR 97223 503.639.4171
TIGARD
Receipt #: 27200900000000000083
Date: 01/12/2009
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
BUP2008-00193 [BUPPLNJ Pln Rv 245-0000-433000 63.45
Line Item Total: $63.45
Payments:
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Check BRADLEE DISTRIBUTORS DLH 032285 By Mail 63.45
Payment Total: $63.45
}
cReceipt.rpt Page I of I
a
II •
. . Community Development
Request for Permit Action RECEIVED TIGARD
TO: CITY OF TIGARD DEC 9 2008
Building Division Services Coordinator CITY OF TIGARD
13125 SW Hall Blvd.,Tigard, OR 97223 BRILDING DIVISION
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor gt City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business orIndividual) --62 pfp t. Je', g cry
J0 $ fl Mailing Address: 1777 o�c.v�t�JOiJe7-6 Q.D b/Co
City/State/Zip: - 2 , O 2- 97 a a�
/ t /
Phone No.: 566-q6S' ?743
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 #: I j tAP ■00 g Oca t4 3
Site Address or Parcel#: tp777 Loy-DI-Fir /?2b -(00
Project Name: j242,pl- Ltt D re,T,Cr 6W-bes
Subdivision Name: 13/tr Lot #: *
EXPLANATION: do t-D I H - 'Tit/S L.Df}S 4 4, 2 I/rn 1.6}-fin,, )
7f_rses_A-L . 0.._2os5 l i gt-e. , APPu c ft t.yT 46-s Pjf_buc b RA�kj
t��t�ItTS t2 1 l l5 IJO rJCo 2 LAcU t
Signature: _ Date: 9. 9. b
Print Name:
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.
e) not more than 80%of the building permit fee 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.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date I f 06 By fir Rte to Bldg Admin: Date ///s//, By g%–' -
Refund Processed: Date Atp-- By r Invoice Processed: Date /0310,f---By
Permit Canceled: Date ! /.c/i ` By.. - Parcel Tag Added: Date By
Receipt# ar-Jyfr Date Method _ Amount$
I:\Building\Forms\RegPermitAction. oc Rev 07/26/07