Fillable TOWN OF SUPERIOR REFUND REQUEST FORM (Town of Superior)

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TOWN OF SUPERIOR REFUND REQUEST FORM (Town of Superior)

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The TOWN OF SUPERIOR REFUND REQUEST FORM (Town of Superior) form is 2 pages long and contains:

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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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Mail Refund Request to:
Name:
Mailing Address:
City: State: Zip:
Requestor’s Phone #:
Requestor’s Email:
Requestor’s Signature:
Reason for Refund Request:
Please attach a along with this form, a copy of the permit (if applicable) and a receipt showing the fees paid in which you
are requesting a refund.
**Please note: Community Development Departments may refund up to 50% of permit fees. Permit fees are
nonrefundable after commencement of construction. Permits considered to be expired are also non-refundable. Plan
Review Fees are non-refundable after completion of the plan review and Zoning Fees are non-refundable after permit
application submittal.***
FOR OFFICE USE ONLY – Fees Paid and Refund Breakdown
Building Safety Fees: $ _ % Refund = = Total Refund $ _
Building Safety Approval: _
Planning & Development Fees: $ % Refund = _ = Total Refund $ _
PlanningApproval:
Impact Fees: IFA _Parks $ Public Safety: $ _ Streets $
Impact Fee Coordinator Approval: _
Public Works Comments/Approval:
Total Refund: $
Manager Approval:
Date:___________________________
Tracking #/Plan #:_________________
Permit #:_________________________
Project Address:_____________________________________________________________________
TOWN OF SUPERIOR
199 N LOBB AVE, SUPERIOR, AZ 85173/520-689-5752
REFUND REQUEST FORM
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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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TOWN OF SUPERIOR REFUND REQUEST FORM (Town of Superior)

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Completed 24 January 2021

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