What is the Request for Refund/Permit Cancellation Form for?

Use it to request a refund or cancel an issued permit, or to withdraw a permit application that has not been issued. The form is for fees paid to the Building Department.

Do I need a notary for the Request for Refund/Permit Cancellation Form?

No. The form requires a signature and date, not a notary. If the refund check recipient differs from the payer, a written authorization letter is required; the form does not specify notarization.

What attachments are needed for a permit cancellation?

Check the applicable attachments listed on the form. Building permit cancellation documents must be originals; copies of electrical or plumbing permits are accepted. A written payer authorization is required if the check recipient differs from the payer.

Escalon, CA · San Joaquin County

No notary required

Request for Refund/Permit Cancellation Form

Property owners, contractors, and other requestors use this form to request a refund, cancel an issued permit, or withdraw an unissued permit application.

What this form is

This form is for requesting a refund or cancellation of fees paid to the Building Department, or withdrawing a permit application that has not been issued. It asks for the job address, requestor and refund recipient information, permit type and number, and reason for the request. Select applicable attachments; building permit cancellation documents must be original.

Who needs it

A property owner, contractor, or other requestor seeking a refund, cancellation of an issued permit, or withdrawal of an unissued permit application needs this form.

How to submit it

Refund requests can be hand delivered or mailed to the Building Department, City of Escalon, 2060 McHenry Ave., Escalon, CA 95320.

About notarization

This form is signed and dated without a notary; any required payer authorization is a written letter, with no notarization or sworn statement specified.

How to submit this form

1
Download The Form
Download the Request for Refund/Permit Cancellation Form.
2
Complete The Form
Enter the job address, requestor and refund recipient information, permit type and number, and reason for the request.
3
Gather Attachments
Check applicable attachments. Building permit cancellation documents must be originals; include written payer authorization if the refund recipient differs from the payer.
4
Sign And Submit
Sign and date the form, then hand deliver or mail it to the Building Department at 2060 McHenry Ave., Escalon, CA 95320.

Frequently asked questions

What is the Request for Refund/Permit Cancellation Form for?: Use it to request a refund or cancel an issued permit, or to withdraw a permit application that has not been issued. The form is for fees paid to the Building Department.
Do I need a notary for the Request for Refund/Permit Cancellation Form?: No. The form requires a signature and date, not a notary. If the refund check recipient differs from the payer, a written authorization letter is required; the form does not specify notarization.
How do I submit the permit refund request?: Hand deliver or mail the request to the Building Department, City of Escalon, 2060 McHenry Ave., Escalon, CA 95320. The form does not list email submission.
What attachments are needed for a permit cancellation?: Check the applicable attachments listed on the form. Building permit cancellation documents must be originals; copies of electrical or plumbing permits are accepted. A written payer authorization is required if the check recipient differs from the payer.

Need something notarized?

This Request for Refund/Permit Cancellation Form doesn’t need a notary — but if you have another Escalon form that does, a commissioned online notary can help.