HomeMy WebLinkAbout1700 Springfield Dr - Miscellaneous - 07/19/1990aff &" ca-0 pt""/ ex
Building Permits & Inspections Division
'$700 s�<<-Iyea4
City of Fort Collins
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.
TU O 0 APPLICANT — 1 q —q V
DATE
001c�l T
PERMIT NUMBER
APPLICATION NUMBER
To Revenue Officer: You may authorize payment in the amount of:
Type of Refund: / Plan Review Fee
`Jy Permit Fee
Sales Tax
Miscellaneous
$ 1.CZ)
Total Amount of Refund
Comments:
Mail Refund to:
*Attach copy of Application AUTHORIZED SIGNATU
=00 LaPorte Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 i,303) 221-6760