HomeMy WebLinkAbout4360 Shadowbrooke Ct - Miscellaneous - 05/17/1993City of Fort Collins
WINNINNEW
Drevelopment Services
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Building Permits at Inspections Ja
Division
CITY OF FORT COLLINS
BUILDING INSPECTION DIVISION
REFUND REQUEST
I hereby authorize cancellation of said permit and/or plan review fee. I
further state that no work authorized by the above permit has been done. I
am requesting that applicable fees be refunded.
SIGNATURE OF APPLICANT DATE 4%,�
�3/07-�2,
PERMIT NUMBER
APPLICATION NUMBER
To Revenue Officer: You may authorize payment in the amount of:
Type of Refund: Plan Review Fee
101-341113
Permit Fee 101-322101
Sales Tax 9000
Miscellaneous
$D�—
Total Amount of Refund
:omments:
Mail Refund to:
*Attach copy of Application AUTHORIZED SIGNATURE
300 LaPorte Avenue • P.O. Box 380 • Fort Collins, CO 80522-0580 • (303) 221-6760