PRE2018-00022 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN F'
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114 . Request for Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
Check(✓)one
kjA- Ivy REFUND OR Name:
INVOICE TO: (Business or Individual)
- uJa ktn Mailing Address:
cir. A-h3 City/State/Zip:
pErtnil". 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#: htII2 2010 - 00023
Site Address or Parcel #: 2 119 AcoO 0
Project Name:
Subdivision Name: q2.24 AV. L 6LAV/JA Lot #:
EXPLANATION: 1 a.[Cibet44ll- CrtkJ A h tag iNSW I U C i R.0 mI '-000ZZ)
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Signature: LCDate:
Print Name: omit( (gyp.{la,
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80°s of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%o of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date ZZ / - B 017;
Refund Processed: Date /1/V.* By.JAZ Invoice Processed: Date By
Permit Canceled: Date 4/2
i/ By ,& Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_ 9231 .doc
Fronts DSTS
Subject: PRE2018-00022
Location: CR - 1 Permit Center
Start: Tue 7/3/2018 9:00 AM
End: Tue 7/3/2018 10:00 AM
Recurrence: Weekly
Recurrence Pattern: every Tuesday and Thursday from 9:00 AM to 10:00 AM
Meeting Status: Meeting organizer
Organizer: -Pre-Apps_CD_Meetings
Required Attendees: #Pre-Application-Conferences
Optional Attendees: Jessica Williams;Al Dickman;Albert Shields; Brady Bullinger; Dylan Bemis
Resources: CR - 1 Permit Center
Call Handling Mode 2: 2
The applicant is considering two different projects for the site. The first idea is a planned unit development/ 11 lot
subdivision for single-family house. The second idea is an assisted living facility. Both would have access from Riverwood
lane and both would install a pedestrian pathway through the site to provide connectivity to 92nd Ave.