Fillable FORM NUMBER: ADDRESS REQUEST Community Development, of Covina (City of Covina)

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FORM NUMBER: ADDRESS REQUEST Community Development, of Covina (City of Covina)

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File type: PDF

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Community Development,
Building and Safety
125 E COLLEGE STREET
COVINA, CA 91723-2199 626-384-5460
WWW.COVINACA.GOV
ADDRESS REQUEST
B
SECTION
FORM NUMBER
2019 CBC
CODE CYCLE
01/01/2017
EFFECTIVE DATE
01/01/2020
REVISION DATE
ADDRESS REQUEST
INTRODUCTION
Address assignments and requests are made by a property owner or project developer. The City
of Covina requires a $395 administrative fee for each new address requested, or for a
change to an existing address. There is NO refund once the request has been processed.
*PLOT/SITE PLAN REQUIRED reference HANDOUT #15 (one copy 8 ½” x 11”)
PURPOSE OF REQUEST
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
EXISTING ADDRESS_________________________________________________________
EXISTING PARCEL NUMBER
___ ___ ___ ___ - ___ ___ ___ - ___ ___ ___
NAME OF REQUESTOR (print)__________________________________________________
CONTACT PHONE NUMBER___________________________________________________
CHECK ONE: OWNER DEVELOPER
I am authorized to submit this request as noted above:
SIGNATURE_______________________________________DATE_____________________
FOR CITY USE ONLY
Cit
y
Map: Tract: Lot:
New Address:
Department Approval:
NOTE: Notification must be made with-in 10 business days off approval to all entities listed below
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FORM NUMBER: ADDRESS REQUEST Community Development, of Covina (City of Covina)

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Completed 3 August 2020

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