(Parcel Identification Number)
JACKSON COUNTY 9-1-1 OFFICE JACKSON COUNTY, NORTH CAROLINA
401 Grindstaff Cove Rd., (Mail) ADDRESS REQUEST FORM
Sylva, NC 28779
(828)586-7573 fax Date of Application:
The following information is required in order to assign you a permanent house number and road name.
This address is necessary for Jackson County to provide you, the homeowner, with adequate emergency
service when a 9-1-1 call is made. Your address will be assigned as soon as possible after your request is
made. (The driveway must be cut in on the property before the address can be generated.) This address
must be posted on your home or at your driveway before a certificate of occupancy can be issued. This
form must be filled out if you are building a new home or placing a mobile home on your property. Leave
this form at the building permit office. The assigned address must be posted on your home or at your
driveway before a certificate of occupancy can be issued.
Homeowner’s Name: Telephone: ______________________
Contractor’s Name: Telephone: ______________________
Road Name: PIN # __________________________
Building Permit #: Lot # (if applicable): ________________
Directions to building site:
Name of nearest neighbor: ____________________________________________________________
Description of new home: (example: 2-story gray house)
If this home is not to be your permanent full-time residence, please list an out of town mailing
address and telephone number where you can be reached.
FOR OFFICE USE ONLY
NEW HOME ADDRESS: