Fillable Planning & Development Department (Maricopa County Telecommunications)

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Planning & Development Department (Maricopa County Telecommunications)

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Planning & Development Department
06/03/2019
501 North 44th St, Suite 200 - Phoenix, AZ 85008 - (602) 506-3301 - (602) 506-3282 fax
www.maricopa.gov/planning
Page 1 of 1
STATE
STATE
STATE
CONTACT SUPPLEMENTAL
The primary contact shall receive all communications, review comments and permit approvals. A secondary contact
is optional and will be for permit record purposes only. If you are a contractor, please complete the CONTRACTOR
INFORMATION & LICENSED CONTRACTOR VERIFICATION box below and verify that you are licensed under ARS Title 32,
Chapter 10, Article 2.
PRIMARY CONTACT INFORMATION
CHECK ONE
AGENT ARCHITECT ENGINEER OWNER SAME AS CONTRACTOR (FILL OUT CONTRACTOR INFORMATION BELOW)
CONTACT NAME
ADDRESS
CITY
ZIP
CONTACT NAME
PHONE
EMAIL
ARCHITECT / ENGINEER INFORMATION
CHECK ONE
AGENT ARCHITECT ENGINEER OWNER SAME AS CONTRACTOR (FILL OUT CONTRACTOR INFORMATION BELOW)
ADDRESS
CITY
ZIP
PHONE
EMAIL
CONTRACTOR INFORMATION & LICENSED CONTRACTOR VERIFICATION
LICENSE NUMBER
TRUST ACCOUNT (IF APPLICABLE)
COMPANY NAME
CONTACT NAME
TRACKING NUMBER:
GOTO(S):
ADDRESS
CITY
ZIP
PHONE
EMAIL
FOR OFFICE USE ONLY
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Planning & Development Department (Maricopa County Telecommunications)

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Completed 18 July 2020

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