HomeMy WebLinkAbout5225 Coralberry Ct - Miscellaneous/Fee Reduction - 11/06/1986! 22S C,c,,C,P rzt C�,
CITY OF FORT COLLINS
BUILDING INSPECTION DIVISION
REFUND REQUEST
Building permit and plan review fees are totally refundable if collected
erroneously. These fees are also partially refundable at the rate of 80
percent of the original amount, if the work authorized by the permit has
not begun, or if the plan is withdrawn or cancelled before any plan
reviewing is done. A request must be made no later than 180 days after
payment before a refund is authorized.
If you wish to obtain a fee refund as the original permittee, attach a
copy of your permit receipt to this completed form.
"I, C Off I'tt GI �Cr' ��( S DVS am holder of building permit
no. dated �/ %�� /"gyp and/or plan
I—T
review no. ,"dated qI
rebv tho Le
cancellation of said permit and/or,plan c eck arYd'r, tat that no
work authorized by the above permit has be done.requesting that
applica le fees be refunded.
gnature
Subscribed and sworn to before
aye this day of 198
:fitness my hand and official seal.
Nly commission expires
Notary Public
TO THE REVENUE OFFICER: Plan Check Fee
Permit Fee
Sales Tax
SEAL:
1116
Date
You may authorize payment in the amount of: 11 9 � - d W
T0: zl1erlit Ca4ef2f(5r S ADDRESS: I) //Ix- 212S 5
�I - l_c'� I'I05. CC n0322-
Bdi ding Inspection Author zation
over 1
r r
TU B -�� � 7���,.�y C�ec�; . Tee �,Jj