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Address Assignment Application

  1. Applicable Department Contact Information
  2. Request Type
  3. Reason for Request
  4. Current Use of Property*
  5. Must include legal description and surveyor information

  6. Proposed Use of Property
  7. Visible north arrow, property lines, building footprint(s), dimensions, driveway(s), building entrance(s), street names, etc.

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

  9. 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.

  10. Leave This Blank:

  11. This field is not part of the form submission.