Fill and Sign the Building Address Change Form

Building Address Application -- Change of Address, Additional Address Assignment, or Address Verification City of _________________ (Name of City) , _________________ (Name of State) - Bureau of Development Services (BDS) ____________________________________________________________________ Staff Use Only: Confirmation of Address BDS Staff Member: _______________________________________________ Date _____________________ [ ] Changed Building Address _____________________________________ [ ] Additional Building Address _____________________________________ [ ] Verification of Building Address_____________________________________ Comments: ___________________________________________________________ Internal Records: Copies to: [ ] Maps [ ] Building Owner ____________________ [ ] TRACS Set-up [ ] Sign-off [ ] Fire Marshal ______________________ [ ] Excel [ ] Verification of Address Requestor: ________________________________ [ ] Other: _____________ [ ] BDS Inspections: _______________ ______________________________________________________________________ Directions: This form is to be completed by the building/property owner or a member of the City Staff from BDS and/or Fire Dept. Inspector when an existing building address is to be changed, an additional building address is to be assigned, or when additional information is needed to verify a building address. If you have a building permit under review this form is NOT necessary. Fee and Contact Information: There is a $_________ fee for a change of building address and for each additional building address from a building/property owner. An additional building address will only be assigned to a new or previously not addressed building entrance. There is no fee for a change of building address or additional building address based on Fire requirements. There is no fee for verification of a building address. If you need additional information, please leave a detailed message on the BDS Addressing Hotline at _________________ (Phone Number) . Applicant Information: Name ________________________________________ Date _________________ Mailing Address _______________________________Zip Code ________________ Phone_______________ FAX ________ e-mail ___________________________ Property Information: [ ] One and Two Family Residential [ ] Commercial & Multifamily Residential Existing Address _______________________________________________________ Quarter Section Maps(s) _____________ Lot __________ Block ____________ Tax ID # ______________________ Addition _________________________ Requestor is: [ ] Building Owner _________________________________________ [ ] Fire Marshal ____________________________ Fire Requirement, _______________ (Name of City) Code Number __________ [ ] Agency Requiring Address Verification ________________________________ Request: [ ] Change Building Address (include site plan below) [ ] Verification of Building Address [ ] Assignment of Additional Building Addresses (include site plan below) Reason: __________________________________________________________ Site Plan Please draw a site plan and include:  North arrow;  Building for which a changed or additional address is being requested. Indicate the current building address;  Streets with street names indicated;  Adjacent building(s) and address of adjacent building(s); and  Floor plan divisions for commercial buildings indicating location of door(s) which need an address. _______________________________________________________________ (Drawing of Site Plan) You are responsible for providing address information to service providers. BDS does provide address information to the parties listed below; however there can be a delay in addressing data being updated and recognized. BDS provides information on changed and additional building addresses to:  USPS Address Management Systems  Qwest Address Management Center  NW Natural Gas  _________________ (Name of City) General Electric  Comcast  _________________ (Name of County) County Assessment and Taxation  _________________ (Name of County) County Cartography and Records Division  Bureau of Emergency Communications  _________________ (Name of City) Water Bureau  Bureau of Environmental Services