Certificate of Occupancy
Clearance Agreement Form
Page 1 of 2
This publication can be made available in alternate formats (Braille, large print, computer diskette, or audiotape)
upon request. Contact Planning and Development at (602) 262-7811 voice or (602) 534-5500 TTY.
S:\Certificate of Occupancy, Clearance Agreement Form.doc TRT/DOC/00128
WEB\dsd_trt_pdf_00128 126-501D Rev. 1/12
Please Print or Type all Information
Per Phoenix City Code (P.C.C) 32-37
Project Name: _______________________________________________________________________________
Project Address: _____________________________________________________________________________
________________________________ ______________________________ ________________________
P&D Project Number Computer Sequential Number Civil Eng. Folder Number
Developer/Owner: ____________________________________________________________________________
Address: __________________________________ City: _________________ State: ______ Zip: _______
Phone: _________________________________________________ Fax: ______________________________
E-Mail: _____________________________________________________________________________________
Type of Construction:
Residential Commercial Industrial Other (Explain) _______________________
_________________________ Number of Buildings ___________________ Number of Lots
*****All Agreements require an 8 ½“x 11” Exhibit indicating affected area*****
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We are authorized to and hereby agree to have occupancy clearance withheld on future construction
permits until all tracts, easements, and right-of-way improvements detailed in Phoenix City Code, Section
32-35 have been installed and accepted by the Planning and Development Department; or until other
means of acceptable assurance been presented to and accepted by the Planning and Development
Department. This agreement is attached to the parcel and subsequent owners are subject to its
provisions. For any additional questions regarding bonding requirements, contact the Planning and
Development Department, Financial Service Section at (602) 262-5026.
Signature: ____________________________________ Name (Print): ________________________________
Title: ________________________________________ Authorized Agent For: _________________________
Agency Address: _____________________________________________________________________________
Date: ________________________________________ Phone Number: ______________________________
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State of Arizona )
) ss.
County of Maricopa )
The foregoing instrument was acknowledged before me this ________________ day of __________________
20 _________________ by ___________________________________________________________________
_____________________________________________ ___________________________________________
My Commission Expires Notary Public
