CITY OF HAPPY VALLEY
16000 SE Misty Drive
Happy Valley, OR. 97086
Phone: 503 783-3800
ADDRESS CHANGE OR ADDRESS
ASSIGNMENT APPLICATION
Property Owner’s Name: _______________________________________________
Mailing Address: _______________________________________________________
City: ___________________ State___________________ Zip: ___________
Daytime Phone number: ____________________________
Request is for:
Լ Change of existing address
Please give current address of property: _______________________________
Լ Assignment of unaddressed property
Please give assessor’s map and Tax Lot Number: ________________________
Describe your request and the reason(s) for this request in as much detail as possible:
___________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I am the property owner of the above mentioned address and submit this address application for processing:
Signature of Property Owner: ____________________________________ Date: _________________
The fee for processing an address change is $216.00. The City’s Ordinance No. 174 addresses the manner
and system in which properties can be addressed. All addressing must be consistent with regional or
established grids of Clackamas County and the City’s ordinance. Your request will be process within these
guidelines.
The City will notify you and all affected agencies of this address change and/or assignment.
This application is for change of property addressing only; not for change of a street name.
FOR STAFF USE ONLY:
Լ Revision of existing address
Լ New Address
Լ Fee paid _______________, Date paid: ____________Receipt No. ____________________
Authorized Signature: _________________________________________
Date processed: ______________________
2
-25-2016
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