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2. 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.
4. This form may only be used to change/update an owner mailing address, billing mailing address, or business name.
6. The Permit Owner Name refers to the entity or sole proprietor that owns the establishment. Management Companies may not be listed as the Owner.
10. Business Information
12. Permit Number(s)*
14. Name of Permitted Establishment*
16. Address*
18. City*
19. State*
20. Zip Code*
24. Update / Change

    1. Owner Mailing Address / Contact
    2. Billing Mailing Address / Contact
25. Permit Card*

    1. Yes
    2. No

    Please check this box if you would like an updated permit card sent to your mailing address.
27. New Mailing Address
29. City
30. State
31. Zip Code
33. Phone Number
34. Email Address
38. Update / Change

    1. Business Name
40. New Business Name
44. Name of Requestor*
45. Title*
47. Phone Number
48. Email Address
Leave This Blank:


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

    This field is not part of the form submission.

54. Submit

* indicates a required field