APPLICATION FOR RESIDENTIAL PERMIT
SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY - ECS Compliance Division
10005 E. OSBORN ROAD, SCOTTSDALE, AZ 85256-9722 PHONE: (480) 362-7910 FAX: (480) 362-5908
Project Valuation:
Building No.:
Construction Type:
Suite No.:
Occupancy:
Sq. FT:
Description of Work/Project:
Name: Email: Phone:
Address: City:
Party Responsible for Payment
Name: Email:
Phone:
Contractor Name: Email:
Phone:
Address: City:
SRPMIC Business Lic. No.: SRPMIC Tax Lic. No.:
AZROC No:
Owner
Name: Email: Phone:
Address: City:
EPNR – Special Notes(Required for ground disturbance)
Environmental Clearance Letter from EPNR has been completed and attached?
Yes: No:
If NO, please contact EPNR at (480) 362-7500 to complete a Request for Environmental Review (RER). The applicant/contractor has read and
understands any stipulations required in the RER and certifies this understanding by signing this permit. In the course of construction, if any
Cultural and/or Archeological items are found, please stop construction immediately and contact EPNR.
TYPE OF SUBMITTAL:
EXPEDITED
Initial to confirm expedited permit. Double plan review fees apply:
the information is correct.
*If Deferred submittal, please specify here:
Contractor/Company Information
Zip:
State:
State:
State:
Zip:
Zip:
SRPMIC String Line Account (if applicable):
This permit becomes null or void if work or construction authorized is not commenced within 180 days, or if construction or work
is suspended or abandoned for a period of 180 days at any time after work is commenced. Applicant hereby waives all claims
against the Salt River Pima-Maricopa Indian Community and the United States of America and agrees to hold the allotee’s, the
Salt Pima-Maricopa Indian Community and the United States of America, free and har
mless from liability for any loss damage or
injury from the use of the premises by applicant together with all costs and expenses in connection therewith.
By signing, I hereby certify that I am the owner or duly authorized owner’s agent, that I have read this application and the
information provided is correct. The granting of permit does not presume to give authority to violate or cancel the provisions of
any of the Salt Pima-Maricopa Indian Community laws regarding construction or the performance of construction.
Sign:
Date:
Applicant/Company Information
