Date:
SUBMIT TO THE TOWNSHIP BUILDING & PLANNING DEPT AT 2400 BYBERRY RD OR EMAIL TO
permitcenter@bensalempa.gov
Applicant’s Name:
Present Address:
E-Mail Address:
Phone No:
FAX No:
PROVIDE PROPERTY INFORMATION FOR THE ADDRESS BEING REQUESTED
Note: One property per request.
Tax Parcel No: 02- Lot No:
Street on Which Property is Located:
Nearest Intersecting Street:
Adjacent House No:
Additional Information:
SKETCH:
A sketch of the area is to be submitted depicting addresses North and South of property
which needs address, as well as existing addresses across the street.
OFFICE USE ONLY
Address Assigned:
Assigned by: Date:
Fire Rescue Review & Approval:
POSTMASTER: NOTIFY US ONLY IF ASSIGNED NUMBER IS INVALID
Township of Bensalem Department of Building and Planning
BENSALEM TOWNSHIP
Building and Planning Department
Office 215-633-3644 ▪ Fax 215-633-3753
2400 Byberry Road ▪ Bensalem PA 19020
REQUEST FOR ADDRESS
PPLICATION
Rev 9/2015
