HomeMy WebLinkAbout2006 Union Dr - Miscellaneous - 05/30/1991Development Services 2206 Union Dr
Building Permits & Inspections 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 MAY 30, 1991
0911100
PERMIT NUMBER APPLICATION NUMBER
To Revenue Officer: You may authorize payment in the amount of:
Type of Refund:
Plan Review Fee
Permit Fee
Sales Tax
STORM DRAINAGE $117.22 Miscellaneous
$ 117.22
Total Amount of Refund
Comments:
Refund Storm Drainage fee per Dottie (6589)
Mail Refund to: Berk Conway
3413 Canadian- Pkw,%.-
Fort Collins, CO 80524
*Attach copy of Application AUTHORIZED SIGNATURE
300 LaPorte Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (303) 221-6760