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:


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

    This field is not part of the form submission.

24. Submit

* indicates a required field