Lake Havasu City, AZ · Mohave County
Valid Licensing Certification
Contractors applying for a building, grading, pool, electrical, or plumbing permit use this form to certify their licensing and Lake Havasu City business license status.
What this form is
This certification is for an applicant seeking a building, grading, pool, electrical, or plumbing permit in Lake Havasu City. It asks for the permit location, contractor and license details, city business license number, printed name, signature, and submittal date. The contractor also affirms that the information is true and accurate and that they hold current licenses.
Who needs it
A contractor applying for a building, grading, pool, electrical, or plumbing permit in Lake Havasu City needs to complete this certification.
How to submit it
Submit the completed form to the Development Services Department, 2330 McCulloch Blvd N, Lake Havasu City, AZ 86403. The form says the signature must be original and copies will not be accepted.
About notarization
This form has no notary block and is signed without a notary; the contractor signs and dates the certification, which includes a sworn affirmation.
How to submit this form
- 1
Download The Form
Download the Valid Licensing Certification PDF.
- 2
Complete The Certification
Enter the permit location, contractor and license details, business license number, printed name, and submittal date.
- 3
Sign The Form
Sign the certification as the contractor. The form requires an original signature; copies will not be accepted.
- 4
Submit To The City
Submit the completed form to the Development Services Department at 2330 McCulloch Blvd N, Lake Havasu City, AZ 86403.
Frequently asked questions
- Who completes the Valid Licensing Certification?
- The applicant for a building, grading, pool, electrical, or plumbing permit completes the form and certifies their contractor licensing and current Lake Havasu City business license.
- What information does the form ask for?
- It asks for the permit location, contractor license number and class, city business license number, contractor's printed name and signature, and submittal date.
- Do I need a notary for the Valid Licensing Certification?
- No. The form has no notary block. The contractor signs and dates it and makes a sworn affirmation.
- How do I submit the Valid Licensing Certification?
- Submit it to the Development Services Department at 2330 McCulloch Blvd N, Lake Havasu City, AZ 86403. The form requires an original signature; copies will not be accepted.
Need something notarized?
This Valid Licensing Certification doesn’t need a notary — but if you have another Lake Havasu City form that does, a commissioned online notary can help.