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DevSvcs-TE-2.0-20171207
Innovative - Responsive - Professional
Permit Cancellation
& Refund Request
Building Services
Submit this completed form in person at City Hall or by email to PermitTechnicians@kirklandwa.gov
REFUND INFORMATION
Date of Request:
Which are you requesting? Choose one:
Cancellation of a permit along with a refund calculated in accordance with KMC 21.74.025 Table 1.
Monetary refund only, without any status change to the permit (for example, overpayment of fees).
Specify the relevant site address:
Specify the relevant permit number:
(Examples: BSF16-02134, MNR15-54312)
Explain the circumstances or details of why this request is being made:
REQUESTER INFORMATION
Provide information about the person making this request.
Name:
Phone Number:
Email Address:
IMPORTANT NOTES
• Attach any documents that may be helpful in processing this request, such as a receipt or invoice.
• Refunds may take up to 4 weeks to process.
• Refunds are subject to the Kirkland Municipal Code (KMC) 21.74.025.
• The recipient of the refund will automatically be the same person or company that originally paid
the invoice. The recipient cannot be changed.
For Office Use Only:
Invoice #
Receipt #
