Fillable Street Name Change Application (City of Gulfport Mississippi)

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Street Name Change Application (City of Gulfport Mississippi)

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The Street Name Change Application (City of Gulfport Mississippi) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for City of Gulfport Mississippi

BROWSE CITY OF GULFPORT MISSISSIPPI (MS) FORMS

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Revision date 11/20/19
Page 1 of 4
If there is more than one applicant, please check this box. In the case of multiple applicants,
the reverse side must be completed. Each additional applicant will need to complete and sign
the reverse of this application. We can only accept applications with original signatures.
SECTIONS A. THROUGH H. MUST BE SUBMITTED FOR A COMPLETE APPLICATION
CITY OF GULFPORT
Urban Development - Planning Division
1410 24th Avenue
Gulfport, MS 39501
(228) 868-5710
APPLICATION FOR
STREET NAME CHANGE
Property Information
Current Name of Street Involved:
_____________________________________________________________________________________
General Location:_______________________________________________________________________
GENERAL DESCRIPTION OF REQUEST:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
___________________________________________________
CERTIFICATION:
I hereby certify that I have read and understand this application and that all information and attachments are true
and correct. I also certify that I agree to comply with all applicable city codes, ordinances and state laws.
Finally, I certify that I am the applicant involved in this request or have authorization to act as the applicant’s
agent for the herein described request.
APPLICANT
____________________________________
Printed Name Of Applicant
____________________________________
Mailing Address
____________________________________
City State Zip code
____________________________________
Home Phone Work/Cell Phone
____________________________________
Email
____________________________________
Signature of Applicant
AGENT
____________________________________
Printed Name Of Agent
____________________________________
Mailing Address
____________________________________
City State Zip code
____________________________________
Home Phone Work/Cell Phone
____________________________________
Email
__________________________________________________
Signature of Agent
For Staff Use Only
Case File #:___________________
Date Received:________________
Receipt #:____________________
Received By:__________________
Zoning: ______________________
Ward: ________Flood:__________
Size:_________________________
Revision date 11/20/19
Page 2 of 4
This page must be completed if there is more than one applicant. All persons listed as applicants must
complete and sign this application.
CERTIFICATION:
I hereby certify that I have read and understand this application and that all information and attachments
are true and correct. I also certify that I agree to comply with all applicable city codes, ordinances and
state laws. Finally, I certify that I am an applicant involved in this request or authorized to act as the
applicant’s agent for herein described request.
NAME OF OWNER (PRINT)
ADDRESS (STREET, CITY, STATE, ZIP CODE
PHONE # (H) (W)
TAX PARCEL NUMBER(S) OWNED
SIGNATURE:
NAME OF OWNER (PRINT)
ADDRESS (STREET, CITY, STATE, ZIP CODE
PHONE # (H) (W)
TAX PARCEL NUMBER(S) OWNED
SIGNATURE:
NAME OF OWNER (PRINT)
ADDRESS (STREET, CITY, STATE, ZIP CODE
PHONE # (H) (W)
TAX PARCEL NUMBER(S) OWNED
SIGNATURE:
(Use additional forms as needed)
IN CASES OF MULTIPLE APPLICANTS, PLEASE IDENTIFY THE PERSON WHO WILL BE ACTING AS YOUR SPOKES
PERSON/AGENT FOR YOU:
Revision date 11/20/19
Page 3 of 4
F. Provide a written statement addressing the
following:
Explain the need for the street name change
State the purpose for the request and what
problem(s) the name change will correct
How the street name change will impact:
o Transportation and Access
o Fire and Police protection
o Other public facilities
Why the proposed street name change will
not create a traffic hazard.
G. Site plan. Please note that approval of your
request, in part, is based on your site plan which
must address the following items:
The street to be renamed (beginning to
ending points).
The property lines and dimensions and street
width have been provided on the drawing.
All parcels of land abutting the street to be
renamed noting addresses or vacant.
Other pertinent information which would
provide an understanding of the requested
action.
H. Cash or check payable to the City of Gulfport in
the amount of $125.00.
Revision date 11/20/19
Page 4 of 4
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Street Name Change Application (City of Gulfport Mississippi)

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Completed 14 July 2020

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