Request For Address Assignment/change Of Address
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1
2PLANNING AND BUILDING DEPARTMENT
714-536-5271
REQUEST FOR
ADDRESS ASSIGNMENT/CHANGE OF ADDRESS
(IN CONJUNCTION WITH FIRE SPECIFICATION NO. 409)
Date:______________________
TYPE OF REQUEST/TO DEPT
FEE
SUBMITTAL REQUIREMENTS
Attached?
New Address Assignment: One (1) reduced (8½”x 11”)
Single Tenant Assignment
site plan.
A reduced floor plan is required for all requests that
NEW ADDRESS ASSIGNMENT
involve multiple units
$ 255
Property owner signature or letter of authorization.
CHANGE OF ADDRESS
Tracts And Major Developments
New Address Assignment: Four (4) full-sized site plans,
one (1) reduced (8½”x 11”) site plan
Digital submittal per specifications on reverse
NEW ADDRESS ASSIGNMENT
$1,256
A reduced floor plan is required for all requests that
involve multiple units
Property owner signature or letter of authorization.
One (1) reduced (8½”x 11”) site plan
METER ASSIGNMENT
$ 135
Property owner signature or letter of authorization.
Applicant Name
Property Owner
Applicant has notified all tenants of address change request?
Address
Address
Telephone Number
Telephone Number
Email Address
Email Address
Legal Description
Assessor Parcel Number (s) (APN):
Tract:
Lot(s) :
Property Address/Location
Reason For Request:
I understand that this request may require installation of new mail receptacles and/or new Certificates of
Occupancies for all properties affected by this address change/assignment.
Applicant’s Signature:
Date:
Property Owner’s Signature:
Date:
For Official Use Only
Application No.
Received By:____________ DM _________ RD _________ Date Received
Gen Plan __________________ Zoning______________Flood Zone______________ Panel #________________________
Approved
Denied By: ____________________________________________
Date: ______________________
Distribution:
Fire Dept, Darin Maresh
Information Services, Leslie Edwards
Police Dept, Marilu Canas
G:ClericalCounter FormsAddress Assignment Application Form.doc
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