Food Establishment Permit Fee Refund Request

Directions

Complete all required fields and submit the form.

Regulatory Reference

In accordance with 18 AAC 31.050(k), an annual permit fee will be refunded if a food establishment:

Pays the fee for an annual permit;
Does not operate within the calendar year; and
Provides documentation and demonstrates to the department’s satisfaction that it was not in operation within the calendar year.

Other permit fees are not refundable, including plan review fees.

Questions?

Please contact the permit coordinator at dec.fsspermit@alaska.gov.

Refund Request Information

Calendar Year of Refund Request*

Select the year of the permit to be refunded, this is the year that the establishment did not operate

Permit ID Number*

Establishment Name*

Name of Person Submitting This Refund Request*

First NameLast Name

Phone Number*

Email*

Confirmation Emailgwashington@email.com

Refund Amount Requested*

Mailing Address for Refund Check*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please explain why you are requesting a refund of the food establishment permit fee.*

Describe any evidence showing the food establishment did not operate during the calendar year of the permit fee to be refunded.*

Upload Supporting Documents

Attach any documentation to support the evidence that the food establishment did not operate during the calendar year of the permit fee to be refunded.

Certification

I hereby request the refund listed above and my documentation is attached. I understand that the documentation must conclusively show that my food establishment did not operate.

I declare, under penalty of unsworn falsification, that this application (including any accompanying statements) has been examined by me and to the best of my knowledge and belief is true, correct, and complete.

Please verify that you are human.*