Current Mailing Address:
City, State, Zip:
*The Email field must be filled out in order for you to receive an email confirmation of your address submission. You will be notified by email that your application has been received*
Municipality of New Structure:
Type of Structure:
Is The Location of the Structure Marked?
we must be able to see the location in order to address it.
Expected Construction State Date:
Please Choose the One that Most Applies:
Wood Frame House
Double Wide Home
Mobile Home/Not In Park
Retail Type Building
Mobile Home/-In Park Lot#
Other Addressable Structure
If Exists, Briefly Describe the Structure (Color, Special Features, Landmarks Nearby):
Direction to the Site (Include Neighbors Names and Addresses, If Possible):
If Possible Include a Copy of Plan of Lots:
Lot Plan Name:
Please answer the question below. This is to help block spam.
'What is five plus five?'
Please put your answer in NUMBER form!