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2. Date
   Date
4. Parcel Number or Schedule Number*

   Search Property Data

5. Legal Description of Property*
7. Owner*
8. Applicant*
10. Phone Number*
11. Email Address*
12. Fax Number
14. Please Note: If above listed property is less than 35 acres and not in a subdivision, please attach a copy of the current Warranty Deed complete with full legal (metes and bounds) description and a copy of the warranty deed with matching legal description recorded prior to January 1, 1975; or a copy of a recorded resolution indicating approval for an exemption from subdivision.
18. County Use Only

    1. Yes

    1. No

    Planning Department
19. Date
    Date
20. Intials
24. Adress request for: (check all that apply)

    1. Permit (building, driveway, septic)

    1. Other (please describe)
25. Description
27. What is the name of the road (county, state, or private) that your driveway will access?*
29. What is the mileage (to the nearest 10th of a mile)to your driveway location from a start of the road or from the nearest mile marker?
31. What are the nearest known addresses on the road accessing the property that this address is requested for?
33. Every attempt is made to assign an accurate permanent address. Park County shall incur no liability in the event re-addressing becomes necessary or the property is deemed not to be a legal building site
35. New Address Request Form
    Printable New Address Request Form
37. For more information contact the Park County Address Coordinator.

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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

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