Demolition Permit Escrow Refund Request

2. Instructions
   Please fill out this form to request a demolition permit escrow release. Fill out one form for each address being requested.

   Please fill out this form to request a demolition permit escrow release. Fill out one form for each address being requested.

4. Permit Number*

5. Escrow Refund Amount*

7. Project Site Street Address*

9. Contractor Company Name*

11. Contractor Mailing Address*

13. City*

14. State*

15. Zip Code*

17. Contact Name for Questions*

19. Contact Email*

20. Contact Phone*

Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field