Fillable PERMIT EXTENSION/RENEWAL REQUEST (Town of Superior)

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PERMIT EXTENSION/RENEWAL REQUEST (Town of Superior)

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The PERMIT EXTENSION/RENEWAL REQUEST (Town of Superior) form is 2 pages long and contains:

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  • 4 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Superior

BROWSE TOWN OF SUPERIOR (AZ) FORMS

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PERMIT EXTENSION/RENEWAL REQUEST
Mail To: Town of Superior
Building Safety Division
Attn: Permit Techs
199 N Lobb Ave
Superior, AZ 85173
Email To: sclark@superioraz.gov
Date:
Permit#:
Project Address:
**A permit that has been expired for less than one year will have a renewal fee of one half of the original permit fee, for
example $1400 (original permit fee) $700 (renewal fee). A permit that is expired for more than one year will have to pay
a full permit fee. **
Due to the following circumstances, I am asking that you extend/renew my permit the allotted 180 days
from date of expiration. (If more space is needed, attach a separate page)
FAX PHONE EMAIL
Fax: Phone:
Preferred Method of Notification (check one): MAIL
Name:
Mailing Address/City/State/Zip:
Email:
Signature:
EXPIRATION DATE:
EXTENDED UNTIL:
RENEWAL FEE:
TOWN OF SUPERIOR
199 N LOBB AVE, SUPERIOR, AZ 85173/520-689-5752
BUILDING PERMIT APPLICATION
********OFFICE USE ONLY********
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199 N Lobb Ave, Superior, AZ 85173 T 520-689-5752
www. superioraz.gov
PROPERTY OWNER AUTHORIZATION FORM
I (property owner)
hereby authorize (owner’s agent)
To make application to Town of Superior for the following (description of work)
Assessor Parcel Number:
PhysicalAddress:
City/Town: State: AZ Zip:
By signing this Form, I acknowledge and agree that I am not released from
responsibility for: (1) the payment of any and all fees associated with the issuance
of any permits, orders, notices or other approvals (“Approvals”) by Town of
Superior pursuant to my agent’s application; (2) the satisfactory completion of all
work authorized by such Approvals in compliance with all applicable county, state
and federal laws, codes, rules, regulations and requirements; and (3) correcting
any violations of the terms and conditions of such Approvals issued by Town of
Superior pursuant to my agent’s application.
Property Owner:
By (signature):
Name:
Phone Number:
Email:
Date:
TOWN OF SUPERIOR
199 N Lobb Ave, Superior, AZ 85173
520-689-5752
(Incomplete applications will not be accepted)
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PERMIT EXTENSIONRENEWAL REQUEST (Town of Superior)

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Completed 24 January 2021

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