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Permit Support Document (56) 0 I U. City of Tigard • coMiv[uNlTY DEVELOPMENT oPMrN'r Dt.PARrN[ � �/0 / Request for Permit Action 97223 -- 14' � � 1 13125 SW I-Iall Blvd. • Tigard, Oregon • 503-718-2439 • a ww.uara cl_ ,t - � .,..)' [P ( -401t TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Rt s I mi Phone: 503-718-2439 Fax: 503-598-196)) Tigardbuilding Permirs(ttitigatd tir.giivl' rz s FROM: Owner Applicant y Contractor i City Staff check(✓)<,nc REFUND OR Name: INVOICE TO: (Business or individual) Ulliiin.t 1 ld.reszi: ) / © J Q�G.. . Col..--fui'►1,^ 'a— kidq.2.–.Oi ' City/State/Zip: )Qf CO(kV CG., 1l9 9'S76 Phone No.: 6,0 -- (/ / I5--- - PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): 1 I CANCEL/VOD PERMIT APPLICATION. RIEFUND P114_,R MIT FEES (attach copy of original receipt and provide explanation lulois), [ IN`,TOICE FOR FEES ES Dl TI (attach case fee schedule and provide explanation helps l). LI REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). C Permit #: C 1 ' " ,e9t9c39 Site Address or Parcel #: „5-1,0�j 1,0 17 i3O�-v� d � p2490 Project Name: _179. nip it)t) 019- Subdivision Name: Lot #: EXPLANATION: R/ / td J F'J - Rp� Pegm/7— La=___64e9,5-7 — - — -- -- - --- Signature: - / Dare: , 2` - 7r _ - - - - Print Name: Refund Yulici 1. 'the city's Community Development Director,Building Official or City l 1pinecr may :tuthor»c the refund • Any fee which sous errone,usic paid cn t ,llected. • Nia m,,rc than t•lfilV,of the appite iti ,ti or plan lc veto-lee when an application is withdrawn or canceled heturc review etfott has hee.i exuende,I. • tlia,, e,, the:apdicati„n(it-hermit tee for 1,a ti peuruts prior to nit u..pecdt , e_lu<e.ts. 2.. P1 refunds will be ceturfeo to i t e orirulsl paver in the fuer,of a r heck ck crit ;5 postal lI ��a.e allr,w > �1 a-eery foe peocc�_atnt;�e and r�rue<�s. i/ 7oP , ;42 S „,fi' 4�OF ICE USE`ONLY ¢ Route to Sys Admin: Date By Route to Records: Dates/�jy/j By v Refund Processed: Date?// / B �.. invoice Processed: Date / By Permit Canceled:aceled: Dat 9i/ R Parcel Tag Added: Date Pt, l:ABuilding At nrins\RryPe,mirlc.rir,n-_19�.�i-Woe — — 1 111 • TIGARD City of Tigard September 17, 2018 Crown Voltage Inc. Attn: Stacy 1403 SE Columbia Ridge Dr Vancouver,WA 98664 Re: Permit No. ELC2018-00539 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 6665 SW Hampton St, Ste 200 Project Name: Hampton Oaks Job No.: N/A Refund Method: ® Check#229717 in the amount of$90.22. ❑ Credit card "return"receipt in the amount of$ . 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 permit was purchased in error. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, , t9"//-e-7-e2--Je---- 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 INIll I a City of Tigard g TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Crown Voltage IncDATE: 9/10/2018 1403 SE Columbia Rdge Dr Vancouver, WA 98664 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 418922 Case#: ELC2018-00539 Date: 8/14/2018 Address/Parcel: 6665 SW Hampton St.,Ste 200 Pay Method: CreditCard Project Name: Hampton Oaks EXPLANATION: Per applicant's request as permit was purchased in error. Refund 80%of permit fees. s� r � e s' er �. ��1f4t Electrical Permit 220-0000-43103 $80.56 12%State Surchar.e 100-0000-24001 9.66 TOTAL REFUND: $90.22 APPROVALS: SIGN; URES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board $ ` Nms=„ „�..'aer „is-, 'a"��"+3Pi:r - e� y���w.�7 a=. r'N'ttge z, x ,.�,,. � ��' '� _ Case Refund Processed: Date: y/,1/,9 B .0'4. I:\Building\Refunds\RefundRequest.doc x 09/01/2010