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OTSEGO COUNTY EQUALIZATION DEPARTMENT 800 Livingston Blvd Ste 1-D Gaylord, MI 49735 Phone: (989) 731-7410 Fax: (989) 731-7418 APPLICATION FOR STREET ADDRESS THERE IS A $25.00 CHARGE FOR A PROPERTY ADDRESS ( ) ( ) Phone # Fax# State Zip Date Applicant Name Email Address Current Mailing Address City Property Code Number 6 9 - - - - - Is this parcel part of a property split occurring since the first of January? Yes No If yes, please include date of land division approval Date Type of Structure to be Built: (Check one) Approximate Start of Construction Home Pole Building Commercial/Industrial Date: Garage Temporary Electrical Tower/Well Site Other Name of Access Road Signature of Applicant BRIEFLY SKETCH PROPERTY BOUNDARIES AND LOCATION OF THE DRIVEWAY PLEASE INCLUDE DISTANCE OF DRIVEWAY FROM PROPERTY LINES Example: Prop Line Distance Driveway Prop Line Access Road OFFICE USE: rev.7/06 OFFICIAL HOUSE NUMBER ASSIGNED TO THIS PARCEL: DATE ASSIGNED: POST OFFICE: Street