Mailing Address:
P.O. Box 4008, MS 401
Chandler, Arizona 85244-4008
Development Services Department
Building Safety Division
215 E. Buffalo St., Chandler Arizona 85225
Telephone: (480) 782-3000
www.chandleraz.gov
Form No. UDM-062/Building
Rev: 12-30-19
________________________________________________________________________________
Facility Name:________________________________ Square footage (
campus total
)______________
Facility Address:___________________________________________________________________
Additional building addresses (
must be on same campus
): _____________________________________
________________________________________________________________________________
________________________________________________________________________________
Facility Agent (
Arizona Registrant or other as approved by the Building Official
) Registrant? ___Y ___N
Name:__________________________________ Phone:_____________ Certificate # ___________
Email Address:____________________________________________________________________
Mailing Address:___________________________________________________________________
By submitting this application you are certifying that the facility owner’s agent currently resides in the state of
Arizona. If the representative moves out of state, or is otherwise replaced, then a new application must be
submitted.
Other facility contact: Name __________________________________Title: __________________
Email Address: ____________________________________________ Phone: _________________
Trust account contact (
if different
) Name:_________________________________________________
Email _______________________________________ Phone ______________________________
For City Use:
Application Fee ________ Trust account _______________ Approved date: _________________
Approved by: Expiration date:
Permit or log #
ANNUAL FACILITIES PROGRAM
Registration Application
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