Fillable Plan Change and or Renewal Right-of-Way PERMIT APPLICATION (City of Tucson)

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Plan Change and or Renewal Right-of-Way PERMIT APPLICATION (City of Tucson)

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The Plan Change and or Renewal Right-of-Way PERMIT APPLICATION (City of Tucson) form is 1 page long and contains:

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Mail: Engineering 4
th
Floor, P. O. Box 27210 Tucson, Arizona 85726-7210 / Email: tdotpermitcenter@tucsonaz.gov
Revision date: 122017
Plan Change Description Required
Plan Change and or Renewal
Right-of-Way PERMIT APPLICATION
For Barricade and Excavation for Construction
INSTRUCTIONS: Please complete entire application with accurate information. If you have any questions, please contact Engineering at
520-791-5100. Save application as a PDF and email to tdotpermitcenter@tucsonaz.gov Forms of payment accepted are check, credit
cards, or City Advance Payment Account (APA).
Charge to Advanced Payment Account Number:
This application is for:
Existing Permit Number:
Plan Add/Change Renewal /Days of Renewal:
Work
Description
:
Start Date: End Date:
Day 9AM-3:30PM Night 6PM-6AM * 24HR Weekend Holiday OTHER
* Residential neighborhood night work requires approval for Temporary Exemption to Noise Permit per Tucson Code Section 16-31(d).
Applicant Information:
Applicant Firm:
Contact Name:
Email:
Phone number:
Office Use Only
Permit #
Staff Initials: Ward: Area:
Expiration:
A/C ADOT ASZ B BS CE CIP/PIA
DW/SD MITZ PM PT RR STC, TRI _____
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Plan Change and or Renewal Right-of-Way PERMIT APPLICATION (City of Tucson)

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Completed 5 August 2020

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