Mesa, AZ · Maricopa County
Occupancy Confirmation Worksheet
This worksheet helps residential care facility applicants confirm a property's occupancy classification and provide facility and resident details to the city.
What this form is
Applicants use this worksheet to confirm the occupancy classification for a residential care facility, including assisted living, behavioral health, foster, group, or sober living homes. It asks for the property address, facility name and type, resident count, sprinkler protection details, and the applicant’s confirmation and signature. If the home has the specified sprinkler protection, the worksheet requests a current third-party fire inspection report.
Who needs it
Applicants confirming the occupancy of a residential care facility should complete this worksheet and provide the requested property, facility, and resident information.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This worksheet is signed and dated without a notary; if the sprinkler question is answered yes, attach a current third-party fire inspection report.
How to submit this form
- 1
Download The Worksheet
Download the Occupancy Confirmation Worksheet PDF.
- 2
Complete Facility Details
Enter the property address, facility name and type, resident count, and sprinkler protection information.
- 3
Gather The Inspection Report
If you answer yes to the sprinkler question, provide a current third-party fire inspection report.
- 4
Sign And Submit
Print your name, sign and date the worksheet, then submit it to the city department named on the form.
Frequently asked questions
- What does the Occupancy Confirmation Worksheet ask for?
- It asks for the property address, facility name and type, number of care residents, sprinkler protection details, and the applicant’s printed name, signature, and date.
- Do I need a notary for the Occupancy Confirmation Worksheet?
- No. The worksheet is signed and dated without a notary. If you answer yes to the sprinkler question, attach a current third-party fire inspection report.
- How do I submit the Occupancy Confirmation Worksheet?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Occupancy Confirmation Worksheet doesn’t need a notary — but if you have another Mesa form that does, a commissioned online notary can help.