Permit Support Document (35) RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAR 7 2018
4 IIR •Re uest for Permit Action CITY Of' TIGARD
TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439•www.tigard-or.golf
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TO: CITY OF TIGARD V 1 0
Building Division %/f� 0 ('/---
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner 64_ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) f .a\,,1 LI e 0_,t c C O
Mailing Address: 14 R'(o C? 5z.„./ ✓e
6 .enS v. ✓) ad
City/State/Zip: o CL rJ. f 0 C. 7 7 -Z 3
Phone No.: 5O' -- (o ?a ci— (/ to Z 7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
Pk_ 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#: e_ L L Z-0 ► 1 — 0 O S S I
Site Address or Parcel#: G<3 30 S c-i Roe);i--a. '2-11
Project Name: at ren.,...i-e- Ccyt f.-o I
Subdivision Name: V3ovtl3-r., (oar ct&rot S Lot#: II
EXPLANATION: 1 Gt,J ct S Ca v. c e.1.t e d
Signature: 1;- Date: 3/7/1 $•
Print Name: !,1v'�'h KR v
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service. /u, 493. Please allow 3-4 weeks for processing refund requests. 7/,0,a–• — --4 , ce-i .. 7
j..:,$ /, 70
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FOR OFFICE USE ONLY �,
Route to Sys Admin: Date By Route to Records: Date, /1? By
Refund Processed: Date e/ By . Inv•ice Processed: Date By
Permit Canceled: Date // By w r 'arcel Tag Added: Date By
I.\ g\Forms\R
Bu ldin c PctmitAcuon�. 231 .doc
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TIGARD
City of Tigard
April 18, 2018
Frahler Electric Company
11860 SW Greenburg Rd
Tigard, OR 97223
Re: Permit No. ELC2017-00581
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 6830 SW Bonita Rd
Project Name: Climate Control
Job No.: N/A
Refund Method: ® Check #228195 in the amount of$63.64.
❑ Credit card"return" receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$
Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov