You can do that using a layout grid with three columns. First is label, second is street, third is number. The other lines, you can merge columns 2 and 3. It is a bit more manual labor compared to regular form, since you will need to set Show Label to No for all input fields, and add an extra text element in the first column.
Other option, a bit more tricky but nicer endresult, is to modify the sass/css files, adding extra classes .inputfield-left and .inputfield-right and doing something with float, width etc.
Or go wild with Bootstrap’s inputgroup.
I think using a table widget is the easiest and most flexible way if you only need this for one row.