Permit, Inspection & Lockbox Application

2. Inspections & Permits:*
   -- Select One --Lock Box - $65.00 one time feeChildcare DES/DCS - $100.00 initial /renewal license inspectionAdult Daycare (DHS) - $100.00 initial /renewal license inspectionFireworks Sales inside building (90 Day) - $150.00 Inspection / PermitResidential Care Home (Nursing, Behavioral & Assisted Living)-$150.00 Initial/renewal license Inspection
4. First Name:*
5. Last Name:*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number:*
16. Alternate Phone Number:
17. Email:
19. Subdivision or Intersection:*
21. Payment Instructions
    Please mail or hand deliver payment to: City of Surprise Attention: Revenue Division 16000 N. Civic Center Plaza Surprise, AZ 85374-7470 Note: As soon as payment is received, a representative from the Fire Medical Department will contact you to schedule an appointment.
Leave This Blank:


22. Print Only

* indicates a required field