Fillable REFUND REQUEST Please submit refund requests to permittech@sammamish.us, (City of Sammamish)

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REFUND REQUEST Please submit refund requests to permittech@sammamish.us, (City of Sammamish)

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Department of Community Development
801 228
th
Avenue SE ■ Sammamish, WA 98075 ■ phone: 425-295-0500 ■ fax: 295-295-0600 ■ web: www.sammamish.us
v: Mar. 5, 2020
REFUND REQUEST
Please submit refund requests to permittech@sammamish.us, and must include a copy of the receipt.
Refunds may only be approved within 180 days from date the application was submitted.
Refunds shall not be issued for an application or plan review if the review has been completed.
Plan review refunds shall not exceed 80% of fees paid when application is withdrawn or canceled
prior the start of the plan review process.
Permit refunds shall not exceed 80% of fees paid when no inspections have been completed.
Refunds will only be issued to the payor of record that paid the fees.
Please allow 3 weeks for processing.
APPLICATION INFORMATION
Date of Application: Date of Request:
Application/Permit #:
Project Address/PIN:
Reason for Request:
PAYOR INFORMATION
Payor:
Company:
if applicable
Mailing Address:
city/state/zip
Email: Phone:
I understand the refund will be issued to the original payor of record that paid the aforementioned fees.
Signature
Date
STAFF USE ONLY
Amount:
Refund
Approval:
Date:
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REFUND REQUEST Please submit refund requests to permittech@sammamish.us, (City of Sammamish)

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Completed 24 January 2021

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