Fillable Property Owner Declaration Form printable pdf download

Property Owner Declaration Form

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City of Tempe

P. O. Box 5002

20 E Sixth Street

Tempe, AZ 85281

480-350-2955

Financial Services Department

Tax and License Division

PROPERTY OWNER DECLARATION

Property Owner or Authorized Agent must complete and submit this form to the Development Services

Department prior to Final Inspection. This form must be on file before Final Inspection will be

approved.

Please answer the following questions:

The property owner will be physically performing ALL the actual alterations and/or construction to the

property

YES

(Circle one)

If answered NO, fill out the information below on the individual(s) or company who performed the alteration and/or construction

2) The property owner will hire contractor(s) or others to perform the actual alteration and/or construction

(Circle

YES

one)

If answered YES, fill out the information below on the individual(s) or company who will perform the alteration and/or construction.

If more than one General/Prime contractor is used, put additional information on the back of this form.

Name

Phone

Address

Individual/Company ROC License #

City Privilege (Sales) Tax Number

Project Value

NOTE: Any materials purchased without paying a City Privilege tax are subject to a 1.8% City use tax.

*It is unlawful for any person to knowingly or willfully reproduce, forge, falsify, fraudulently obtain or secure, or aid or abet

another in any attempt to reproduce, forge, falsify, or fraudulently obtain or secure, an exemption from taxes imposed by

the City of Tempes Ordinance. The violation of any provision shall constitute a Class One Misdemeanor. The

undersigned swears and affirms that the information herein is true and accurate.

Signature (Owner or Authorized Agent): ______________________________________________

Name: ____________________________ Title: ____________________ Phone #: _____________

Building Permit #: ______________________________________________

Property Owner Name: ______________________________________________________

Property Owner Address:

___________________________________________________

Property Owner Phone #:

___________________________________________________

Project Address: ____________________________________________________________

Return to:

City of Tempe, Development Services Department

Building Inspection

31 E 5

Street, Tempe, Arizona 85281

FAX: 480-858-2073

(Revised 1/7/2010)

Property Owner Declaration Form

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