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LAKE DILLON FIRE PROTECTION DISTRICT

Residential Property Address Display Application Form

Please complete the following form to order an aluminum address plate for display near the primary road and access driveway to your residence.  All address numbers will be 5” in height in white reflective numerals with a brown or green reflective background.  The aluminum address plates can be set-up for either vertical or horizontal display depending upon the preference for mounting and visibility. 

Name of Property Owner:  _______________________________________________________

Cell or Telephone #:  ____________________       E-mail Contact:  _______________________

Physical Address Numbers as Assigned by County or Town:  ­­­­­­­­­­­­­                                      .

     Orientation on Plate:    ___ Horizontal   or   ___ Vertical       Background Color:  ___ Green   ___ Brown

Road or Street Name/Number:  ________________________ Town:  ___________ Zip Code:  ________

Do you require assistance with placement and/or installing the address plate?    ___ No   ___ Yes

Cost Assessment

                                                                                                                                 Quantity                 Cost            Total

6” X 24” Aluminum Address Plate (3 or 4 numerals)   $15 per plate      ___            $_____        $_____

6” X 30” Aluminum Address Plate (5 numerals)   $15 per plate              ___            $_____        $_____

7’  Pre-drilled steel mounting post (optional)  $17.50 each                    ___            $_____        $_____

                                                                    Total Amount Due and Paid:                                                          $______

Method of Payment:    ____ Checks Only        Date Paid:  ____________     Check #____________

I understand from the date this order is submitted it may require up to 45 – 75 days for the address plate to be produced and delivered.   

________________________________________                     ________________________________

       Property Owner / Resident Signature                                                                      Date

 

Grant funding for the address program for residential property owners served by the Lake Dillon Fire Protection District has been 50% funded by the Board of County Commissioners and the Summit County Wildfire Council from revenue generated from the County’s Wildland Fire Mitigation and Suppression Fund.  The 50% funding has been factored into the cost extended to the property owner / resident.       Visit us at our web site:  www.ldfr.org

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Office Use Only           Address Verification Completed by:  ___________________   Date: ____________________

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