Fillable MCDOT Right-of-Way Reservation Action Request Form (Maricopa County Telecommunications)

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MCDOT Right-of-Way Reservation Action Request Form (Maricopa County Telecommunications)

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The MCDOT Right-of-Way Reservation Action Request Form (Maricopa County Telecommunications) form is 1 page long and contains:

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  • 12 check-boxes
  • 16 other fields

Country of origin: US
File type: PDF

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MCDOT Right-of-Way Reservation Action Request Form
Note: Incomplete applications may result in delay of review.
Owner’s Name: ______________________________________________________
*If change in ownership within the past year, please attach deed.
Transportation Systems
Manag
ement Division
2901 W. Durango Street
Phoenix, AZ 85009
Phone: 602-506-4176
Fax: 6
02-506-8758
ww.
mcdot.maricopa.gov
Applicant’s Name (if not owner): ________________________________________
* Please attach authorization letter
Phone: (_____) _______-_________ Email: _____________________________
Mailing Address: _____________________________________________________
* Approval letter will be mailed to the listed address.
Assessor’s Parcel Number: _____________________________________________
Building Permit Number: ___________________________________________
Location of action request, check all that apply: N S E W
Reason for Request (be specific as possible): ______________________________
___________________________________________________________________
Applicant’s Signature: __________________________ Date: ________________
FOR MARICOPA COUNTY USE ONLY
Copy of Property Deed Attached? _____ Yes _____ No _____ Not Applicable
Authorization Letter Attached? _____ Yes _____ No _____ Not Applicable
Application Fee - $75.00
Receipt #________________________ Date: _______________
Received By: ____________________________
Comments: ________________________________________________________
MCDOT Contact Phone Number: (602) 506-4176
Rsvd 05/11/2018
Owner Address
Applicant Address
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MCDOT Right-of-Way Reservation Action Request Form (Maricopa County Telecommunications)

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Completed 6 August 2020

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