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Administrative Change Request Form

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