Permit Renewal Form - San Rafael

Property Address * Required
List all permit numbers you would like to be cancelled associated with this property * Required
Only permits that have not started construction or received any inspections, are NOT associated with a Code Enforcement Case or a Stop Work Order can be cancelled. * Required
- I am the legal property owner
- I am the contractor listed on the permit
- I am the authorized agent for the Owner
**Please note: If you are a contractor or a 3rd party agent and you are not listed on the permit we will need additional documentation or acknowledgement from the property owner allowing you to act on their behalf**
Is this permit eligible for a refund? Would you like us to check?
- Yes, please check
- No
**If a refund is approved, any services performed by the department and processing fees will be deduced from your refund. It may take up to 3 weeks to receive and will be credited back to the initial payee **
Name * Required
First Last
Company Name
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number * Required
Email * Required
Additional info:
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