street address application
CARPINTERIA-SUMMERLAND FIRE PROTECTION DISTRICT FIRE PREVENTION DIVISION 1140 Eugenia Place, Suite A Carpinteria, California 93013 (805) 684-4591 / Fax (805)684-8242 566-0463
STREET ADDRESS APPLICATION PROPERTY OWNER
DATE Last Name
First Name Initial
Mailing Address Street
City
Fax
State
Zip
Telephone
Applicant (if different from owner) Last Name
First Name Initial
Mailing Address Street
City
Fax
State
Zip
Telephone
Signature / Comments ASSESSOR PARCEL NO. (APN) ADDRESS TYPE (please check one) New Residential
Additional Residence(s)*
Change Residential*
New Commercial
Additional Commercial*
Change Commercial*
*ADDRESS TO BE REVIEWED Street Number/Name
Please provide a drawing or map showing location of access road and relative location of parcel. Copy of Address Assignment to PAYMENT
$
Applicant
Owner Date
Check # TO BE COMPLETED BY THE FIRE DISTRICT
ADDRESS ISSUED Street Number/Name
Area
Inspector
Date Issued
COMMENTS Copies To Rev: 1/2009
Station #
Other
STREET ADDRESS APPLICATION PROPERTY OWNER
DATE Last Name
First Name Initial
Mailing Address Street
City
Fax
State
Zip
Telephone
Applicant (if different from owner) Last Name
First Name Initial
Mailing Address Street
City
Fax
State
Zip
Telephone
Signature / Comments ASSESSOR PARCEL NO. (APN) ADDRESS TYPE (please check one) New Residential
Additional Residence(s)*
Change Residential*
New Commercial
Additional Commercial*
Change Commercial*
*ADDRESS TO BE REVIEWED Street Number/Name
Please provide a drawing or map showing location of access road and relative location of parcel. Copy of Address Assignment to PAYMENT
$
Applicant
Owner Date
Check # TO BE COMPLETED BY THE FIRE DISTRICT
ADDRESS ISSUED Street Number/Name
Area
Inspector
Date Issued
COMMENTS Copies To Rev: 1/2009
Station #
Other
