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All applications for a medical marijuana-related facility conditional use permit shall meet the requirements listed in Chapter 19.20, Conditional Use Permits, as well as the requirements listed below:

(A) Provide a notarized authorization executed by the property owner, acknowledging and consenting to the proposed use of the property as a medical marijuana-related facility;

(B) Provide the legal name of the medical marijuana-related facility;

(C) If the application is for a medical marijuana cultivation facility, state the name and the location of the medical marijuana dispensary(ies) with which it is associated;

(D) Provide the name, address, and birth date of each officer and board member of the nonprofit medical marijuana dispensary;

(E) Provide a copy of the operating procedures adopted in compliance with the Arizona Revised Statutes;

(F) If an individual, the individual shall state his/her legal name and any aliases and submit proof that he/she is twenty-one (21) years of age;

(G) If a partnership, the partnership shall state its complete name, and the names of all partners, whether the partnership is general or limited, and a copy of the partnership agreement, if any;

(H) If a corporation, the corporation shall state its complete name, the date of its incorporation, evidence that the corporation is in good standing under the laws of its state of incorporation, the names and capacity of all officers, directors, and principal stockholders, and the name of the registered corporate agent and the address of the registered office for service of process;

(I) If a limited liability company, the company shall state its complete name, and the names of all members who own a twenty (20) percent or greater interest in the capital or profits of the limited liability company. If the management of the limited liability company is vested in a manager or managers, the company shall also state the name of each person who is a manager of the limited liability company;

(J) If the applicant intends to operate the medical marijuana-related facility under a name other than that of the applicant, he/she must state the medical marijuana-related facility’s fictitious name and submit the required registration documents;

(K) State whether the applicant, or a person residing with the applicant, has been convicted of a specified criminal activity as defined in this chapter, and, if so, the specified criminal activity involved, the date, place, and jurisdiction of each;

(L) State whether the applicant, or a person residing with the applicant, has had a previous license under this chapter or other similar medical marijuana-related facility ordinances from another city or county denied, suspended, or revoked, including the name and location of the medical marijuana-related facility for which the permit was denied, suspended, or revoked, as well as the date of the denial, suspension, or revocation, and whether the applicant or a person residing with the applicant has been a partner in a partnership or an officer, director, or principal stockholder of a corporation that is licensed under this chapter whose license has previously been denied, suspended or revoked, including the name and location of the medical marijuana-related facility for which the permit was denied, suspended, or revoked as well as the date of denial, suspension, or revocation;

(M) State whether the applicant or a person residing with the applicant holds any other licenses under this chapter or other similar medical marijuana-related facility ordinance from another city or county and, if so, the names and locations of such other licensed businesses;

(N) Provide the classification of license for which the applicant is filing;

(O) Provide the location of the proposed medical marijuana-related facility, including a legal description of the property, street address, and telephone number(s), if any;

(P) Provide the applicant’s mailing address and residential address;

(Q) Provide a recent photograph of the applicant(s);

(R) Provide the applicant’s driver’s license number, Social Security number, and/or his/her state or federally issued tax identification number;

(S) Provide a sketch or diagram showing the configuration of the premises, including a statement of total floor space occupied by the business. The sketch or diagram shall be professionally prepared and must be drawn to a designated scale or drawn with marked dimensions of the interior of the premises to an accuracy of plus or minus six (6) inches;

(T) Provide a current certificate and straight-line drawing prepared within thirty (30) days prior to application by a registered land surveyor depicting the property lines and the structures containing any existing medical marijuana-related facility within two hundred (200) feet of the property to be certified and also depicting the property lines of any established use listed in Chapter 19.90 within five hundred (500) feet of the property to be certified. For purposes of this section, a use shall be considered existing or established if it is in existence at the time an application is submitted;

(U) Provide a copy of all documentation provided to the state as a requirement for state licensing;

(V) Provide evidence that all requirements of this chapter, as well as all applicable building, fire, and health codes, have been or will be met and are in compliance with said adopted codes and regulations. (Ord. No. 2011-02, §§ 1, 2, 1-18-11. 1976 Code § 15-1-67(H))