HomeMy WebLinkAbout609 WHEDBEE ST - MISCELLANEOUS - 2/2/1994City of Fort Collins
Community Planning and Environmental Services
Building Permits and Inspection 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.
ignature of Applicant
Permit Number
To Revenue Officer:
Type of refund
Date
Application Number
You may authorize Payment in the amount of:
a1�. LL
577. S(D
17i7. oa
$ ';)-(,-�og, 72)
Total Amount of Refund
Plan Review Fee 101-341113
Permit Fee 101-322101
Sales Tax 9000
Miscellaneous
1 U
Mail Refund To:
AUTE6RfZED SIGNATURE
*Attach copy of application or permit
281 North College Avenue 9 P.O. Box 580 • Fort Collins, CO 80522-0580 • (303) 221-6760