Form Center

Steps

1. Page 1 - Instructions for Submission This section is complete This section is incomplete
2. Page 2 - Contact Information This section is complete This section is incomplete
3. Page 3 - Permit Questionnaire This section is complete This section is incomplete
4. Page 5 - Review Notice This section is complete This section is incomplete
5. Page 6 - Review and Sign This section is complete This section is incomplete

Page 2 - Contact Information

Business Information (Name on Establishment)
Business Name*
Address*
City*
State*
Zip*
Phone*
Business Owner Information (Responsible Party)
Entity Type*
1. Sole Proprietorship (Must show lawful presence)
2. Corporation
1. Association
2. Other
If Other, please describe:
Owner/Corporation*
Address*
City*
State*
Zip Code*
Phone Number*
Fax Number
Email Address
Mailing/Billing Information
1. If same as above, please check box.
Owner Name
Address
City
State
Zip Code
Phone
Fax
Email Address
Inspection or Plan Review Response Contact
1. If same as above, please check box.
Inspection Contact Name
Address
City
State
Zip Code
Phone
Email Address
Continue |Go Back

Page 3 - Permit Questionnaire

Brief description of what is being requested:*
Please be as detailed as possible to convey to the reviewer what will be taking place at the establishment.
Supporting Documentation
Please upload supporting documentation. Please upload documentation to the cloud drive (instructions below) if file size exceeds 20MB.
Additional Supporting Documentation
Please upload any additional supporting documentation. Please upload documentation to the cloud drive (instructions below) if file size exceeds 20MB.
Additional Supporting Documentation
Please upload any additional supporting documentation. Please upload documentation to the cloud drive (instructions below) if file size exceeds 20MB.
Additional Supporting Documentation
Please upload any additional supporting documentation. Please upload documentation to the cloud drive (instructions below) if file size exceeds 20MB.
Additional Supporting Documentation
Please upload any additional supporting documentation. Please upload documentation to the cloud drive (instructions below) if file size exceeds 20MB.
Plan Review Cloud Drive
Link to the cloud
Please use this link to upload files for plan review (layout).
Instructions for uploading files to the cloud:
Instructions
Please ensure you follow instructions to ensure application is processed and reviewed without delay.
Continue |Go Back

Page 5 - Review Notice

ARS § 11-1604. Prohibited acts by county and employees; enforcement; notice
A county shall not base a licensing decision on whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule, ordinance or delegation agreement. A general grant of authority does not constitute a basis for imposing a licensing requirement or condition unless the authority specifically authorizes the requirement or condition.
Unless specifically authorized, a county shall avoid duplication of other laws that do not enhance regulatory clarity and shall avoid dual permitting to the maximum extent practicable.
This section does not prohibit county flexibility to issue licenses or adopt ordinances or codes.
A county shall not request or initiate discussions with a person about waiving that person's rights.
THIS SECTION MAY BE ENFORCED IN A PRIVATE CIVIL ACTION AND RELIEF MAY BE AWARDED AGAINST A COUNTY. THE COURT MAY AWARD REASONABLE ATTORNEY FEES, DAMAGES AND ALL FEES ASSOCIATED WITH THE LICENSE APPLICATION TO A PARTY THAT PREVAILS IN AN ACTION AGAINST A COUNTY FOR A VIOLATION OF THIS SECTION.
A COUNTY EMPLOYEE MAY NOT INTENTIONALLY OR KNOWINGLY VIOLATE THIS SECTION. A VIOLATION OF THIS SECTION IS CAUSE FOR DISCIPINARY ACTION OR DISMISSAL PURSUANT TO THE COUNTY'S ADOPTED PERSONNEL POLICY.
THIS SECTION DOES NOT ABROGATE THE IMMUNITY PROVIDED BY SECTION 12-820.1 OR 12-820.02.
Continue |Go Back

Page 6 - Review and Sign

Delivery of Inspection Reports
Pursuant to A.R.S. § 41-1009, the Department may enter your establishment to conduct inspections. You have the right to receive a copy of the Department's inspection report at the time of the inspection, within thirty (30) days after the inspection, or as otherwise provided by federal law. I agree that the Department may send me a copy of its inspection report by e-mail or by facsimile transmission to the e-mail or fax number provided under the Business Ownership Information provided above. It is the responsibility of the permit holder to update the Department if there is a change in contact information.
I understand until such time as this variance is granted, I must cease operations that require a variance. I understand that by submitting this application and the fee in no way guarantees my variance will be approved. Also, the Department may initiate action to withdraw my variance if it is granted and an unforeseen health hazard occurs as a result of the variance. Upon withdrawal, the variance operation will immediately cease and desist until another variance is obtained.
Acknowledgement of Notice and Disclosure*
1. I have reviewed the notice and disclosures.
I hereby certify that the above information is correct, agree to comply with the Maricopa County Environmental Health Code, agree to allow the regulatory authority access to the establishment as specified under § 8-402.11 and to the records specified under §§ 3-203.12 and 5-205.13 and Subparagraph 8-201.14(D)(6), and I fully understand that any deviation from the above without prior permission from the Maricopa County Environmental Services Department may nullify final approval. By checking the check box and typing your name you have digitally signed this application.
Application Acknowledgement*
1. I agree the application is true and correct.
Arizona law, A.R.S. § 11-1605(I), allows Maricopa County Environmental Services Department (MCESD) and the applicant for a license to mutually agree to extend the plan review time frame by 50 percent of the substantive time frame and overall time frame. MCESD will agree to any applicant's request for an 50 percent extension of the substantive review time frame and overall time frame when box is checked and signed below.
Licensing Time Frame Extension Acknowledgement
1. I agree to the 50 percent extension.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Disclaimer
Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law. This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under Arizona law.
Electronic Signature

Leave This Blank:

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

This field is not part of the form submission.
Submit Submit and Print | Go Back

Search Forms:

Variance/HACCP Application (Web Form)

Steps

Page 1 - Instructions for Submission

Page 2 - Contact Information

Page 3 - Permit Questionnaire

Page 5 - Review Notice

Page 6 - Review and Sign

Using This Site

Residents

Visitors