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AND BE CLEARY LEGIBLE: *APPLICATION MUST BE COMPLETED (Maricopa County Telecommunications)

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Maricopa County Department of Transportation
2901 W. Durango Street, Phoenix, AZ 85009
(602) 506-7848 or (602) 506-6216
Application for Permit: To Move Oversize / Overweight Vehicles
ALL APPLICATIONS NEED TO BE FAXED TO Fax: 602-506-4009 (NO E-MAILS ACCEPTED)
AND BE CLEARY LEGIBLE: *APPLICATION MUST BE COMPLETED BY THE PERM1TTEE*
IF INCOMPLETE: MUST RESUBMIT A COMPLETED APPLICATION WITH ATTACHMENTS
Applicant ___________________________________
Address ______________________________________
City __________________________________________
State ___________________________ Zip __________
Phone
Email
Mobile H ome / Buildi ng Permit s On ly
AVT:
Zoning Clearance:
Building Permit:
C22 Lic: Exp:
Date(s) to be moved:
MCDOT ROUTE REQUIRED: __________________________________________________________________________________
Load Type: ________________
Address from: _______________________________
Address to: __________________________________
PLATE
WEIGHT
AXL
Truck
Trailer
Jeep/Dolly
Jeep/Dolly
Load
Other
TOTAL
Gross WT
Applicant's Signature: _________________________________ Print: Date: _____
MCDOT Traffic Approved / Denied by: __________________________________________ DATE: _______________________
*ANY MOVE AT OR OVER 16' REQUIRE A ROUTE SURVEY
*LOADS TOTALING 160,000 OR GREATER REQUIRES: TRUCK SCHEMATIC AND AXLE VALUES (VEHICLE TRAIN SCHEMATIC, INCLUDING
PUSH AND/OR PULL TRUCKS, AND LOAD) SAMPLE FORM(S) ATTACHED
*APPLICATION REQUIRES UP TO 3 BUSINESS DAYS FOR REVIEW. APPLICATIONS SUBMITED AFTER
3:00
PM WILL NOT BE REVIEWED
UNTIL THE NEXT BUSINESS DAY (EACH REVIEW VARIES)
REVISED 10/02/13EV
Length
Width _____________ Heigh t ________ Front Overhang ___________ Rear Overhang
Fax
click to sign
signature
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TRUCK PLAN
VIEW with
dimensions
(SEE EXAMPLE)
TRUCK
ELEVATION
VIEW with
dimensions
(SEE EXAMPLE)
Axle Number TOTAL
Axle width (ft) WEIGHT (lbs):
Load (lbs) per axle
No of tires per axle
NOTES: Adjacent axles carrying exactly similar loads, tires, and dimensions may be grouped in the axle table. (See attached example for clarification.)
All information shown on this page must be actual weights and dimensions pertaining to the permit application vehicle.
A PERMIT SUBMITTED WITH INCOMPLETE OR INCONSISTENT DATA WILL BE DENIED. Certified axle and/or tire weights may be required.
Load Description: Applicant Company:
Load Weight: lbs Applicant Contact Name:
Date Load to be Moved: Applicant Phone Number (required):
Date this form was completed: Applicant email address (optional):
Total Length of Permit Vehicle*: Maximum Overall Width*: Maximum Overall Height*:
(*include push/pull vehicles)
This line to be completed by MCDOT Permit Agent only: Received by: Date received:
AXLE TABLE
PERMIT VEHICLE CONFIGURATION (THIS FORM MUST BE ATTACHED TO OSOW PERMIT APPLICATION)
APPLICATION MUST SHOW ACTUAL PERMIT VEHICLE SCHEMATIC, INCLUDING PUSH AND/OR PULL TRUCKS, and LOAD
TRUCK PLAN
VIEW with
dimensions
TRUCK
ELEVATION
VIEW with
dimensions
Axle Number 1 2 - 3 4 - 5 - 6 7 - 8 - 9 10 - 11 - 12 TOTAL
Axle width (ft) 8 8 10 10 10 WEIGHT (lbs):
Load (lbs) per axle
12,000 24,950 23,800 23,700 24,950 279,250 LBS
No of tires per axle
2 2 4 4 4
NOTES: Adjacent axles carrying exactly similar loads, tires, and dimensions may be grouped in the axle table as shown in the example above.
All information shown on this page must be actual weights and dimensions pertaining to the permit application vehicle.
A PERMIT SUBMITTED WITH INCOMPLETE OR INCONSISTENT DATA WILL BE DENIED. Certified axle and/or tire weights may be required.
Load Description: Applicant Company:
Load Weight: Applicant Contact Name:
Date Load to be Moved: Applicant Phone Number (required):
Date this form was completed: Applicant email address (optional):
Total Length of Permit Vehicle*: Maximum Overall Width*: Maximum Overall Height*: 17'-3"
(*include push/pull vehicles)
This line to be completed by MCDOT Permit Agent only: Received by: Date received:
I. Agent
23-Dec-1999
PERMIT VEHICLE CONFIGURATION (SAMPLE TRUCK SCHEMATIC, AXLES, AND TIRE VALUES SHOWN HERE)
APPLICATION MUST SHOW ACTUAL PERMIT VEHICLE TRAIN SCHEMATIC, INCLUDING PUSH AND/OR PULL TRUCKS, and LOAD
AXLE TABLE
123ABC Transport
J. Doe
(SAMPLE DATA SHOWN IN ITALICS ON THIS EXAMPLE FORM:)
J.Doe@myemail.xyz
Electrical Transformer
120,000 lbs
15'-9"
167'-7"
555-555-5555
January 1, 2000
December 22, 1999
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AND BE CLEARY LEGIBLE: *APPLICATION MUST BE COMPLETED (Maricopa County Telecommunications)

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Completed 6 August 2020

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