HomeMy WebLinkAbout900 Constitution Ave - Correspondence/Other - 01/12/19890
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not begun, or if the plan is withdrawn or cancelled before any plan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.
am holder of building permit
no. dated. 1//Z/,,I and/or plan
review no. dated I hereby authorize
cancellation of said permit and/or plan check and further state that no
work authorized by the above permit has been done
applcable�fees be refunded.
Signature
I ari requesting that
Date
Subscribed and sworn to before
me this day of , 198
Witness my hand and official seal.
My commission expires
Notary Public
SEAL:
TO THE REVENUE OFFICER: F_Fee 00
Permit Fee
Sales Tax
You may authorize payment in the amount of: Z S C'0
TO:(�L6C/4k.J&1(_6 C ADDRESS: S/ 5 / ./V -
Building nspection thorization
1 10 '0 -z4- i_cp
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