Date: ___________________________

To:	The City of St. Augustine Beach 
	370 AlA Beach Boulevard, Building 4
        St. Augustine Beach, Florida 32084

Subject:   Address & 911 Street Number Change Request

From____________________________to___________________________

AKA Lot (s) __________Block _______Subdivision _________

Attached is the subject request. For further information, the
person(s) named below is/are the property owner (s) or contact
person (s) for the property owner (s) on the subject street.

Name (s) ______________________________________________________

Address ______________________________________________________

City ______________ State ____________ Zip Code ________

Home phone ____________________ Work phone ______________________

Respectfully submitted (must be signed by property owner (s)),




Property owner (s) must submit and enclose with Address & 911 Street
Number Change Request form the warranty deed and legal description
of property and survey map. One copy of Address & 911 Street Change
Request form and all required enclosures must be sent to St. Johns
County E-911 Addressing, c/o Tim Wehking, 4010 Lewis Speedway,
St. Augustine, Florida, 32095, and another to the United States Post
Office at 99 King Street, St. Augustine, Florida, 32084.



Signature of Building Official ____________________ Date _______