HomeMy WebLinkAbout925 QUAIL RUN - MISCELLANEOUS - 12/10/1987CITY 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not begun, or if the plan is withdrawn or cancelled before any plan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.
�77 t
and/or plan
am holder of building permit
no.+idated r - C -
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. I am requesting that
applicable fees be refunded.
Signa
Subscribed and sworn to before
me this day of 1 198
Witness my hand and official seal.
My commission expires SEAL'
Notary Public
2 /G )o
Date
TO THE REVENUE OFFICER: Plan Check Fee J J ./
Permit Fee �- Q
Sales Tax 2 35
You may authorize payment in the amount of:
TO: RU pr ( . Qu f1 ADDRESS:
'1
bulolcling Inspection AuEr'071-MaTion