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2. ENVIRONMENTAL SERVICES DEPARTMENT
   esd.maricopa.gov
   
3. 
4. WATER AND WASTE MANAGEMENT DIVISION
   Poolinspection@Maricopa.gov
6. NEW OWNER/NEW PERMIT APPLICATION FOR A PUBLIC OR SEMI-PUBLIC SWIMMING POOL OR SPA
   (Please Note: Each body of water is required to have a separate operating permit)
10. FACILITY INFORMATION
12. 1. Facility Name:*
14. 2. Pool Address:*
15. City:*
16. Zip:*
18. 3. Facility Contact Name:*
19. Phone #:*
21. 4. Email Address:*
25. NEW OWNER’S INFORMATION
27. 5. OWNERS Name*:*
    * Owner listed should match what is listed on business license and tax id and should not be a management company. Please provide Home/Condo Owners information if applicable.
28. Phone #:*
30. 6. Address:*
31. FAX #:
33. 7. City:*
34. State:*
35. Zip:*
37. 8. Email Address:*
39. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. 9. Owner's Electronic Signature:*
45. BILLING INFORMATION
47. 10. CONTACT Name:*
48. Phone #:*
50. 11. Management Company/Agent Name:*
51. Phone #:
53. 12. Address:*
54. FAX #:
56. 13. City:*
57. State:*
58. Zip:*
60. 14. Email Address:*
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

* indicates a required field