SALT RIVER
PIMA-MARICOPA INDIAN COMMUNITY
ECS COMPLIANCE DIVISION
10005 EAST OSBORN ROAD / SCOTTSDALE, ARIZONA 85256-9722
PHONE (480) 362-7910 FAX (480) 362-5908
Permit Application
Check Box for Expedited Plan Review
(AdditionalFeesWillApply)
Name and Date:
Permit Type
Project Name
New BuLlding Permit Sign Permit
Construction Type
Tenant Improvement Haul Permit
Occupancy
C of O Residential-New
Project Valuation
Civil Permit Residential- Remodel
Location of Project
Electrical- Commercial Residential-Electrical
SRP/ SWG/ Propane Residential- Haul
Commercial Demo Residential- Demo
1.
Applicant Name
Contact Name
2.
Mailing Address
City/State
Zip
3.
Phone
Mobile
Email
4.
Architect/Engineer
AZ License
Phone
5.
6.
Contractor Name
Contact
Phone
Address
AZ License
7.
SRPMIC Bus. License
SRPMIC Tax License
8.
Description of Project
SQUARE FOOTAGE
Floor Area
Storage Area
Garage Area
Basement
Patio
Total
Fire Sprinklers
Fire Alarm
EPNR - Special Notes
*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 contractor has read and understood 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 at (480) 362-7500
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 River Pima-Maricopa Indian Community, and the United States of America free and harmless from
liability for any loss damage or injury from the use if the premises by applicant, together with all costs and expenses in connection
therewith.
By Signing Below; I hereby certify that I am the owner or duly authorized owner’s agent, that I have read this application and
that all information is correct.
Signature Date
NOTES: Please see the specific submittal requirement sheets for the project type you are requesting a permit for. Submittal requirement sheets are
available at the front counter of the Engineering and Construction Services Department.
Phone
Owner
Email
Address
