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PFI2019-00310 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT _ . COMMUNITY DEVELOPMENT Permit#: PF12019 00310 13125 SW Hall Blvd.,Ti Date Issued: 10/01/2019 T(fad Id 1-313125OR 97223 503.718.2421 9 Parcel: 2S111AD20300 Jurisdiction: Tigard Site address: 14944 SW 89TH CT Subdivision: LADY APPLE Lot: 27 Project: Eykelbosch Sewer Project Description: Replace short section of sanitary sewer that has a sag. Replaced sewer lateral is on site and off site. Repairs will result in removal and replacing one section of public sidewalk, approximately 5'x 6.2'. Class of Work: FEES Type 2-Sidewalk/Driveway Approach Description Date Amount PFI Permit Fee 10/01/2019 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.ticiard-or.dov to schedule inspections online. Contractor: MT HOOD EXCAVATION 744 SE ROBIN WAY GRESHAM, OR 97080 PHONE: 5034591076 Applicant: EVAN EYKELBOSCH 14944 SW 89TH CT TIGARD, OR 97224 PHONE: 5419080798 Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact information of responsible parties before beginning work. Permittee/Applicant Signature: Issued By: .' / Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2019-00310 Type: Condition Name: Status: Severity: PFI_Sidewalk/[ 14-UTILITY NOTIFICATION Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987. If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holder's expense PFI_Sidewalk/[ 15-UTILITY LOCATION CONFLICT Applied Notice Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work with affected utility agencies. PFI_Sidewalk/[ 16-TEMPORARY PATCH Applied Notice A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is liable for hazards or damage resulting from the prosecution of the work. PFI_Sidewalk/[ 17-REPAIR OF EXISTING FACILITIES Applied Notice Work under this permit shall include repair of existing facilities(roads,ditches,etc.)as may be necessary, as determined by the Inspector, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the applicant's expense. PFI_Sidewalk/[ 18-SEWER SYSTEM TEST Applied Notice A sewer system air-test and/or DVD T.V.test report and one set of"As-Builts"shall be provided for review and approval. PFI_Sidewalk/[ 19-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>, to establish a preconstruction meeting. PFI_Sidewalk/[ 20-NOTICE TO COMMENCE WORK Applied Notice The applicant shall notify the City's Inspector twenty-four(24)hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. PFI_Sidewalk/[ 21 -PERMIT/PLAN ON SITE Applied Notice A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan and all amendments shall be readily available at the work area. All work shall conform to the permit terms, conditions and provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work performance. PFI_Sidewalk/[ 22-DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports,on a weekly basis,to the City's Inspector. PFI_Sidewalk/[ 23-MONUMENT PROTECTION Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI_Sidewalk/[ 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense. PFI_Sidewalk/[ 25-EMERGENCY CONTACTS Applied Notice Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)persons who have authority to resolve problems,take corrective action and, in general,will be responsible in case of any emergency. The applicant shall notify the City Inspector, in writing, of any/all assignment changes. PFI_Sidewalk/[ 26-RIGHT OF ENTRY/EASEMENTS Applied Notice Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. PFI_Sidewalk/[ 27-PRIVATE PROPERTY AGREEMENTS Applied Notice Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction activity. PFI_Sidewalk/[ 28-AS-BUILT DRAWING Applied Notice One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance (Certificate of Compliance). PFI_Sidewalk/[ 31 -OTHER Applied Notice Other PFI_Sidewalk/[ 01 -WORK SITE REQUIREMENTS Applied Notice Applicant must comply with all applicable provisions of federal and state law, the Tigard Municipal Code, and the terms of any agreement with the City of Tigard regarding work to be done pursuant to this permit. PFI_Sidewalk/[ 02-WORK SITE AREA Applied Notice The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. The spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up and suspension of work to accomplish clean-up. PFI_Sidewalk/[ 03-WORK SITE EROSION CONTROL Applied Notice Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to accomplish effective erosion control. PFI_Sidewalk/[ 04-WORK SITE REPAIRS Applied Notice Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be reinstalled or replaced,with like kind of material. Obtain City approval of restoration work. PFI_Sidewalk/[ 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices [MUTCD]for Streets and Highways", U.S. Dept.of Transportation, FHWA,current edition,American Traffic Safety Services Association [ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH]. PFI_Sidewalk/[ 06-TRAFFIC CONTROL PLAN Applied Notice Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work area.Traffic control devices,flag persons, etc., shall be in place prior to initiation of construction work and shall be effectively maintained. PFI_Sidewalk/[ 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and area wide Emergency Services: 503-629-0111 (Tigard Police Dept., Tualatin Fire&Rescue)and to 503-962-8140(Tri-Met) and 503-431-2345 (Tigard School District)and other service providers impacted by such closure. PFI_Sidewalk/[ 08-TRAFFIC CONTROL ADVANCE WARNING Applied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours(min.)before initiation of construction work. PFI_Sidewalk/[ 09-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service.Obtain City approval of any access closures. PFI_Sidewalk/[ 10-TRAFFIC CONTROL WORK HOURS Applied Notice Work is permitted in daylight between the hours of 7:00 a.m.to 7:00 p.m. Mon-Fri unless otherwise authorized by the City. PFI_Sidewalk/[ 11 -TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m.to 9:00 a.m. unless authorized by the City Engineer. PFI_Sidewalk/[ 12-TRAFFIC CONTROL MODIFICATION Applied Notice The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. PFI_Sidewalk/[ 13-DRAINAGE CONTROL Applied Notice Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective drainage control. RECEIVED SEP 16 2019 3110 ■ City of Tigard ITY OF TIGARD PFI#:��G('OO' ^ 0 ENGINEERING DEPART�NING/ENGINEERING TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFORMATION TYPE OF WORK Project name: Eykelbosch Sewer ❑ TYPE 1—Franchise Utility Work Replace short section of sanitary sewer that has a sag. performed by NWN,PGE, or utility Brief description of project: P ry agency Replaced sewer lateral is onsite and offsite.Repairs will result in removal and replacing one IBJ TYPE 2—ROW Sidewalk/Driveway/Sewer section of public sidewalk.Approx dimensions 5'x6.2.' Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and 14944 SW 89th Ct;Tigard OR 97224 main line tap Location (address if available): g ❑ TYPE 3—Full Scale Development Work performed with land use approval which includes any of the following: • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Name: Evan Eykelbosch • Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address: 14944 SW 89th Ct water service area City/State: Tigard,OR Zip: 97224 0 TYPE 4—Small Cell Technology ❑ TYPE 5—Tigard Triangle Phone: Email: eveykelb@yahoo.com Phone: 541-908-0798 NOTE: Type 1 and 2 applications may be emailed to rowpermits(dgard-or.gov. Contact name: Phone: Email: CONTRACTOR INFORMATION ❑ Same as applicant Name: Mt Hood Excavation CCB Number: 216556 Mailing address: 744 SE Robin Way City/State: Gresham OR Zip: 97080 Phone: 503-459-1076 Email: hoodexcavation©outlook.com ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ estimate<$5,000 (within the public right-of-way) Is work related to a LAND USE DECISION? ❑Yes ®No Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as"Applicant" shall be designated "Permittee"and shall provide financial assurance for work,if required by the city pursuant to TMC 15.04.140. * With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,when the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner. The owner must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owner's signature on the application. I, the applicant,certify that: • To the best of my knowledge,all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. Evan Eykelbosch 9/13/2019 Applicant's or authorized agent's signature Print name Date Evan Eykelbosch 9/13/2019 Property owner's signature (if required) Print name Date � STAFF USE ONLY , Case No:T t p H2O O 3i O Permit f:$ 336° pt Received by: I ► , Date: Approved by: COb ►dy Date: 1' ((0' I c( Notified by: /\1 ' Date: RP City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PFI Permit Fee.See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7%(less the initial PFI Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. 1012 57:11 P l S1:ONLY FOR STAFF l SE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3: DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? 0 Yes 0 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): ❑Small Cell 0 Macro ❑ Street Name How many install sites are proposed as part of this permit ❑ Site ddress application? TYPE 3-Must provide 4 sets of plans (sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: 0 Public Right-of-Way ❑Private Property ❑ Cover—Site,Vicinity,Abbreviation,Legend If equipment is to be located on private property,describe the CI General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 9 sly "y " SI Edge of Pavement "fes Ditch �' I Streetlight —•—•—•—•—•—•—•—r—•— •{ 1xau, At I � ate. ® r • �1 Mti /d'SelirverTine" • ' T--P I c. I 1 .-( 1 Existing House . r i Existing 1 F. i Driveway . m� Of I 1 O ^ H ti a 1 aI t 0 Existing Shop i J 1 L •�' ole 1 «J- p r 1 Power – I • o o ..."--gb." . I I� 95' I �///I I 9 I Fire Hydrant(FH) i I II Scale: 'I"=30' I i I I TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) x North arrow X Property lines&dimensions Existing utilities locations (sewer, storm,water) x Street& street names X All existing structures x Proposed work X Existing curb or edge of pavement Utility&street light poles x Existing S/W or D/W apron N/A Slope of property X Trees City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4 • tip ##}}+k i#i� +# ##ii•F}+}4}}#}'�'i}#i}#}4i.li}ti t4,F}}+t#4#}44i4 ♦ ` 't 'i*}th}}++•,' i Legend .'.,...*.+4.:14.4..v...41, + + t t+• }+• }+ � r 6 }} } .h}}ttt#+•' t 4#.1.trF:74.,.T.++;go. }} ...74.45T.i } ,i,: _. •. , t # t i#�l.. • #t+ #.:tt t +t#�#,i.,+#.#, }, +#rk+}###, � 14944 SW 89th Ct ,,• j••' 1 .{♦'1 #}#,tt}#}#} N.L4,A$.•++'• i °y�, t wa•'.x„sn _Y i• !:? r +... 1 t.:. ... ,,,,,,, ;,:. ":„....,...,... . . . 4..... \ 1. : ys • y 1 '66°1* �t ... ,„.„°: s' �. • r s` 1� 44Z . :_ t. • . 411 \ fp 2 , .. r ' �,"I'' °k `t a 1 a �' ti . • t ' a-,♦ • r e- w .." , . 4 f.... ) `° CONES AND TAPING TO r 1> 1 ;11PROTECT WORK AREA . -- ttr ° =4 j REPLACE It �� • �' •. <' SIDEWALKi t i 4 PANEL ..:= , ....44.4. - • "It f a '�IFIWA '' EXISTING • 1 �`" ; .�`` ,. .. " a SANTARY LATERAL PORTION OF SANITARY —^ ` r •r `• 4 , ' I LATERAL TO BE REPLACED _ `< x• UNDER PLUMBING PERMIT . " ; 0 . 'tf` x Ii 494 SW 89th Ct � 4 . . . . � • � � % 4,. , p M 43 c PROPERTY LINE "` ,� �� I !. •,,- «,fix S. i, , r s l:-4#12::$1.:::k.:: f� � r l star '•• ♦ t� ",+✓,. i" '' ,4' Goo le}Ea h Y • . • ,- 4� q • 1,, • g , r •r N 1,4': 100 ft li III TIGARD City of Tigard April 3,2020 Evan Eykelbosch 14944 SW 89'Ct Tigard, OR 97224 Re: Permit No. PFI2019-00310 Dear Applicant: The City of Tigard has canceled the above referenced permits) and encloses a refund for the following: Site Address: 14944 SW 89th Ct Project Name: Eykelbosch Job No.: N/A Refund Method: ® Check#235119 in the amount of$240.00. ❑ Credit card"return"receipt in the amount of$ . 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 no work was performed in the right of way. Refund 80% of application fee. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Ornelas Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov ' City of Tigard 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: Evan Eykelbosch DATE: 3/19/2020 14944 SW 89th Ct Tigard, OR 97224 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 426176 Case#: PFI2019-00310 Date: 10/1/2019 Address/Parcel: 14944 SW 89th Ct Pay Method: Check Project Name: Eykelbosch EXPLANATION: Per applicant's request as no work was completed in right of way;refund 80%of application fee. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount PFI Permit Fee 640-0000-43114 $240.00 TOTAL REFUND: $240.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff '1045 If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: `l'/V7/ By: /. ' (/ L\Building\Refunds\RefundRequest.dot x 09/01/2010 CITY OF TIGARD RECEIPT I ' 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Eykelbosch Sewer Site Address: 14944 SW 89TH CT /�.A../LS Receipt Number: 436231 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12019-00310 $-240.00 Total: $-240.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 235119 DHOWSE 09/03/2021 $-240.00 Payor: Evan Eykelbosch Total Payments: $-240.00 Balance Due: $240.00 Page 1 of 1 CITY OF TIGARD RECEIPT ;; ; ••. 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TrCAA13 Project Name: Eykelbosch Sewer Site Address: 14944 SW 89TH CT 0�/� /6 (�9-L' Receipt Number: 426176 - 10/01/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12019-00310 PFI Permit Fee 640-0000-43114 $300.00 Total: $300.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1127 SWARREN 10/01/2019 $300.00 Payor. Evan Eykelbosch Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1 VO D City ofDEVELOPMENT Tigard • COMMUNITY DEPARTMENT 3 Request for Permit Action I I G A R D 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov HL C IVED TO: CITY OF TIGARD Building Division FEB 4 2020 13125 SW Hall Blvd.,Tigard,OR 97223 STY F TIGARD Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermit�ff VISION FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(1)one REFUND OR Name: / INVOICE TO: (Business or Indio dual) �i, A_ / ,/ Apr SGK Mailing Address: (/CYgL( 564} g f7-14 Gf City/State/Zip: Phone No.: t5-tf I- `08-cf3'79.e PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. s' REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR PEES DUE (attach case fee schedule and provide explanation below). Permit#: I F_L c-9 o i 9 - e6 3/() Site Address or Parcel#: (Ciqqtf Cc-0 Br"' e r Project Name: '!/ii.A,tj ��y� Subdivision Name: Lot#: EXPLANATION: /V v f .?2 k (N 12CSC • .. J2- ie".1 d 7'LJ f'jJ' / 7Z4.,-->1T N/trS Signature: Date: OA/7_c' Print Name: �vt � �YI'CL1 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°/n 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. J!>OO, FOR OFFICE USE ONLY Route to S,s Admin: Date ��� B ' Route to Records: Date jc ' B it/ Refund Processed: Date 9 Bye, Invoice Processed: Date By Permit Canceled: Date i j/ By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_12051 . oc