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Brief Reason Why Cancellation or Refund Is Requested and provide a brief scope of work.
Please be advised that a qualifying refund will be made payable to the original payer on record.
Business Name
Total amount of inspection fees paid.
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Only 80% of inspection fees will be eligible for a refund.
Address refund is payable to
Please upload the receipt that confirms proof of payment.
Please upload any documentation that support the work not being done.
Upload original signed permit.
Your request will not be processed without the completed Permit Refund Request form, proof or letter of cancellation, and receipt. Please allow 2-3 weeks for a refund check by mail.
This field is not part of the form submission.
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