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2. 
4. Request Type

   1. Apply for New Address
   2. Apply for Address Change
   3. Address Verification
8. Reason for Request

   1. Construct a new building on a parcel with no address
   2. Split or Join Parcels
   3. Demise or Combine suite(s) in a multi-tenant building
   4. Preliminary Addresses for Development Plan Application
   5. Other
9. Additional Description*
11. Current Use of Property*

    1. One or Two-Family Residential
    2. Multiple-Family Residential
    3. Commercial
    4. Commercial - Office
    5. Commercial - Retail
    6. Vacant
12. Boundary Survey

    Must include legal description and surveyor information

14. Proposed Use of Property

    1. One or Two-Family Residential
    2. Multiple-Family Residential
    3. Commercial
    4. Commercial - Office
    5. Commercial - Retail
    6. No Change in Use or Occupancy
15. Site Plan

    Visible north arrow, property lines, building footprint(s), dimensions, driveway(s), building entrance(s), street names, etc.

17. Property Owner of Record

    Real Estate Parcel Information can be obtained from the Duval County Property Appraiser's Office website.

    
    

19. Current Property Address*
20. Parcel ID Number*
22. Alternate Address
23. Alternate Parcel ID Number
25. Alternate Address
26. Alternate Parcel ID Number
28. Applicant Name*
29. E-Mail Address*
30. Applicant Phone Number*
32. Mailing Address*
34. City*
35. State*
36. Zip Code*
38. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that: 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
40. Electronic Signature
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field