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Administrative Change Request Form
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This form has been modified since it was saved. Please review all fields before submitting.
Permits are not transferable. If this business has a new owner, a new permit application is required- please contact (602) 506-6824 for more information.
This form may only be used to change/update an owner mailing address, billing mailing address, or business name.
The Permit Owner Name refers to the entity or sole proprietor that owns the establishment. Management Companies may not be listed as the Owner.
Business Information
Permit Number(s)
*
Name of Permitted Establishment
*
Address
*
City
*
State
*
Zip Code
*
Update / Change
Owner Mailing Address / Contact
Billing Mailing Address / Contact
Permit Card
*
Yes
No
Please check this box if you would like an updated permit card sent to your mailing address.
New Mailing Address
City
State
Zip Code
Phone Number
Email Address
Update / Change
Business Name
New Business Name
Name of Requestor
*
Title
*
Phone Number
Email Address
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