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2. Instructions

   Please fill out this form as completely as possible.

   For questions, please contact 336-727-2624 or email inspectionrefunds@cityofws.org.

4. First Name*
5. Last Name*
7. Phone Number*
9. Email Address*
11. Permit Number*
13. Project Address*
15. Company Name*
17. Reason for refund request?*
19. Duplicate Permit

    Is this refund request because this is a duplicate permit?

    1. Yes

    1. No
20. Valid Permit Number

    If yes, what is the valid permit number for this job?

22. Signature

    The applicant hereby certifies and agrees as follows:

    1. That he/she has read the above information and it is true and correct;
    2. If any information supplied by applicant is incorrect or missing, refund issuance may be delayed.
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field