Permit Application for Aerial Strand-Mounted Microcell Antenna (A.R.S. §9-584)

This is an application for a permit to install microcell equipment within the City of Phoenix. This is pursuant to the terms and conditions of City Contract No. 142253. The contract name is "Strand‐Mounted Microcell Antennas Between Third‐Party Poles In Right‐Of‐Way and the Site License in the form of Exhibit A, as incorporated by this reference."

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Contact Information

Date

Name of Company*

Contact Name*

E-mail Address*

Phone Number*

Quarter Section*

(You may specify up to 5 sites. Click the "Next" button to add more sites.)

Site

CMRS Carrier Customer for this location*

Location Address*

Utility Job Number*

Pole 1: Location of the Pole and Aerial Strand:*

Feet of the intersection of and

Pole Owner*

Pole ID Number*

Pole Height (Overall)*

Strand Height at Pole*
feet inches

Height Above Ground Level to Lowest Point on Antenna:*
feet inches

Paint Color of Antenna*
(According to Pre‐approved Palette, if applicable)

Please attach the following required documents
(maximum file upload size is 20MB):

Letter of Authorization from Pole Owner to Install ASMA

Photograph (2 elevations N/S and E/W) of the nearest pole

Photograph of Pole ID with location of the "COX Microcell" Marker

Copy of Pre-approved Standard Detail Plan for pole

Add Site

CMRS Carrier Customer for this location*

Location Address*

Utility Job Number*

Location of the Pole and Aerial Strand:

Feet of the intersection of and

Pole Owner*

Pole ID Number

Pole Height (Overall)

Strand Height at Pole
feet inches

Height Above Ground Level to Lowest Point on Antenna:
feet inches

Paint Color of Antenna
(According to Pre‐approved Palette, if applicable)

Please attach the following required documents
(maximum file upload size is 20MB):

Letter of Authorization from Pole Owner to Install ASMA

Photograph (2 elevations N/S and E/W) of the nearest pole

Photograph of Pole ID with location of the "COX Microcell" Marker

Copy of Pre-approved Standard Detail Plan for pole

Add Site

CMRS Carrier Customer for this location*

Location Address*

Utility Job Number*

Location of the Pole and Aerial Strand:

Feet of the intersection of and

Pole Owner

Pole ID Number

Pole Height (Overall)

Strand Height at Pole
feet inches

Height Above Ground Level to Lowest Point on Antenna:
feet inches

Paint Color of Antenna
(According to Pre‐approved Palette, if applicable)

Please attach the following required documents
(maximum file upload size is 20MB):

Letter of Authorization from Pole Owner to Install ASMA

Photograph (2 elevations N/S and E/W) of the nearest pole

Photograph of Pole ID with location of the "COX Microcell" Marker

Copy of Pre-approved Standard Detail Plan for pole

Add Site

CMRS Carrier Customer for this location*

Location Address*

Utility Job Number*

Location of the Pole and Aerial Strand:

Feet of the intersection of and

Pole Owner

Pole ID Number

Pole Height (Overall)

Strand Height at Pole
feet inches

Height Above Ground Level to Lowest Point on Antenna:
feet inches

Paint Color of Antenna
(According to Pre‐approved Palette, if applicable)

Please attach the following required documents
(maximum file upload size is 20MB):

Letter of Authorization from Pole Owner to Install ASMA

Photograph (2 elevations N/S and E/W) of the nearest pole

Photograph of Pole ID with location of the "COX Microcell" Marker

Copy of Pre-approved Standard Detail Plan for pole

Add Site

CMRS Carrier Customer for this location*

Location Address*

Utility Job Number*

Location of the Pole and Aerial Strand:

Feet of the intersection of and

Pole Owner

Pole ID Number

Pole Height (Overall)

Strand Height at Pole
feet inches

Height Above Ground Level to Lowest Point on Antenna:
feet inches

Paint Color of Antenna
(According to Pre-approved Palette, if applicable)

Please attach the following required documents
(maximum file upload size is 20MB):

Letter of Authorization from Pole Owner to Install ASMA

Photograph (2 elevations N/S and E/W) of the nearest pole

Photograph of Pole ID with location of the "COX Microcell" Marker

Copy of Pre-approved Standard Detail Plan for pole

Submit

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Permit Application for Aerial Strand-Mounted Microcell Antenna (A.R.S. §9-584)

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