Medical Marijuana - City of Glendale

PLANNING
Community and Economic Development
Department
DATE STAMP
TIME ____________
MEDICAL MARIJUANA RESEARCH
Internal Use Only
Taken By: Application No.: Fee:________
BUSINESS INFORMATION:
Name of Business:
Address: Suite #:
City: State: Zip Code:
Type of Facility: Dispensary Cultivation Facility Infusion Facility
Parcel Number:
Size of Facility (in square feet):
Email:
PROPERTY OWNER:
Name: Phone: Fax:
Address:
City: State: Zip Code:
TO REPRESENT ME IN THIS APPLICATION, I GIVE AUTHORIZATION TO:
Name: Phone: Fax:
Address:
City: State: Zip Code:
Email:
TO BE COMPLETED BY PROPERTY OWNER:
(Print or type name of owner of record) (Owner of record Signature) (Date)
* By signing this form, the property owner acknowledges that a medical marijuana facility is proposed to be
located on the above mentioned property. Property owner information will be verified upon research by city
staff.
Internal Use Only
Zoning District:
Council District:
Approved: Denied: Date: Expiration Date:
_________________________________________
Planner Signature
CITY OF GLENDALE * 5850 WEST GLENDALE AVENUE * GLENDALE, ARIZONA 85301-2599 * (623) 930-2800

PLANNING
Community and Economic Development
Department
MEDICAL MARIJUANA RESERVATION
DATE STAMP
TIME:
__________________
Internal Use Only
Taken By: Application No.: Fee:________
BUSINESS INFORMATION:
Name of Business:
Address:
City: State: Zip Code:
Type of Facility: Dispensary Cultivation Facility Infusion Facility
Parcel Number:
Size of Facility (in square feet):
Email:
PROPERTY OWNER:
Name: Phone: Fax:
Address:
City: State: Zip Code:
TO REPRESENT ME IN THIS APPLICATION, I GIVE AUTHORIZATION TO:
Name: Phone: Fax:
Address:
City: State: Zip Code:
Email:
TO BE COMPLETED BY PROPERTY OWNER:
(Print or type name of owner of record) (Owner of record Signature) (Date)
* By signing this form, the property owner acknowledges that a medical marijuana facility is proposed to be
located on the above mentioned property. Property owner information will be verified upon research by city
staff.
Internal Use Only
Zoning District:
Council District:
Approved: Denied: Date: Expiration Date:
_________________________________________
Planner Signature
CITY OF GLENDALE * 5850 WEST GLENDALE AVENUE * GLENDALE, ARIZONA 85301-2599 * (623) 930-2800