[District of Columbia - Department of Buildings & Department of Licensing and Consumer Protection] Permit Operations Division Refund Request

Section 1 of 1 in this document

The form you are trying to access has moved. Please access the Permit Operations Division Refund Request Form at its new location by selecting the link below:

https://forms.dc.gov/ng/fa/permitrefundrequest

Building Permit Number

Replacement Building Permit Number

9-Digit Tax Number (No spaces or dashes)

Reason for Refund Request

Reason/Explanation for Refund Request

IMPORTANT: The permit/application must be cancelled if refund is a result of erroneous filing or cancellation before your request can be considered. Please submit a Permit/Application Cancellation Form.

Upload Notarized Permit/Application Cancellation Form

Click Here to Upload

Were you issued a Building Permit?

Yes

Upload Building Permit

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Amount to be Refunded

What method of payment was used for this transaction?

Upload Proof of Cash Payment (i.e., receipt from DOB Cashier's Office).

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Upload Proof of Check Payment (i.e., front and back of cashed check)

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Please enter the first (6) six and last four (4) digits of credit card number used for transaction. (i.e., 1234-56xx-xxxx-7890)

Upload Proof of Credit Card Payment (Receipt)

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Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DOB Cashier's Office)

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If any additional payments are associated with this request, please select the additional method of payment.

Upload Proof of Cash Payment (i.e., receipt from DOB Cashier's Office)

Click Here to Upload

Upload Additional Proof of Check Payment (i.e., front and back of check)

Click Here to Upload

Upload Proof of Credit Card Payment (Receipt)

Click Here to Upload

Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DOB Cashier's Office)

Click Here to Upload

Upload any documents (excluding proof of payment) that support your refund request.

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Title of Requestor

Requestor's Phone Number

Requestor's Email Address

To Whom Should the Refund be Made? (i.e., Business, Inc. c/o Jane Doe)

I certify that the above statements on this application are true and complete to the best knowledge and belief. I agree to comply with all applicable laws and regulations of the District of Columbia. I/We understand that, anyone who makes a false statement on this form can be criminally prosecuted; and, if convicted, fined up to $1000, imprisoned up to 180 days, or both, under D.C. Official Code § 22-2405.

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First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Permit Address

Full Name

Premise Address (Location of Business Operation)

Upload Notarized Permit/Application Cancellation Form

Were you issued a Building Permit?

Upload Building Permit

Upload Proof of Cash Payment (i.e., receipt from DOB Cashier's Office).

Upload Proof of Check Payment (i.e., front and back of cashed check)

Upload Proof of Credit Card Payment (Receipt)

Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DOB Cashier's Office)

Upload Proof of Cash Payment (i.e., receipt from DOB Cashier's Office)

Upload Additional Proof of Check Payment (i.e., front and back of check)

Upload Proof of Credit Card Payment (Receipt)

Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DOB Cashier's Office)

Upload any documents (excluding proof of payment) that support your refund request.

Full Name of Party Requesting Refund

Refund Mailing Address (P.O. Boxes not accepted)

Sign Here