HomeMy WebLinkAbout4765 Simms StreetCity of Wheat Ridge
Community Development Department
Memorandum
TO: Accounting Department
FROM: Kim Cook, Building Division
SUBJECT: Refund for Permit
DATE: June 14, 2018
Reason: Homeowner cancelled project, Permit No. 201709517 is cancelled for
4765 Simms Street.
Please refund: Contractors License$ (acct 01-510-00-513)
80% permit fee: $ 112.72 (acct 01-510-00-516)
100% plan review $ (acct 01-550-05-551)
100 % use tax: $ 140.90 (acct 01-500-02-505)
Total Refund Due: $ 237.86
TO:
Permit Services
980 Hopper Avenue
Santa Rosa, CA 95403
Thank You!
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Permit Technician
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City of Wheat Ridge Municipal Building 7500 W. 29ih Ave. Wheat Ridge, COI (
80033-8001 P: 303.235.2855 F: 303.237.8929
Refund Application
Complete this application in its entirety, attach all copies of permits, permit cards (if issued) and receipts that
were received at the time of permit issuance. Requests for more than 80 percent of the amount paid will not be
approved without prior approval from the Building Official. The refund application must be received by the
Wheat Ridge Building Division no later than 180 days after permit issuance. Applications received after 180
days of permit issuance will not be approved. You can mail or hand -deliver all required documents to: City of
Wheat Ridge, Attn: Building Division, 7500 W. 291h Ave., Wheat Ridge, CO 80033.
Company Name/Name (to whom check should be made out to): Permit Services
Address: 980 Hopper Ave
City: Santa Rosa
State: CA
Zip:_ 95403
Phone: 801710-2507 Fax: Email: jamie@reedvsetgo.com
Permit #: 2017-09517 Permit Address:_ _ 4765 Simms St, Wheat Ridge, CO 80033
Reason for request: Home owner has cancelled the contract and no longer wants the work done.
Printed Name: Jamie Reed Signature: 6, Datc: 6/7/18
For office use only
This request has been: Approved ,-I Denied Refund Amount: $2 / ti
Approved by: &yn � � Date: 113
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