Name:

Please fill in all information below so that we may better serve you.  Required fields are marked by *.

Location of Code Violation (Address)* : 

Cross Streets (if known):   

Code Violation Description* :      
          

Property Manager:

Street Address:    

City:                                          State: 

Zip Code:             

Phone:                    

Property Owner:   

Street Address:    

City:                                          State: 

Zip Code:             

Phone:                    

Building Use (Dwelling, Apartment, Construction Site, Office, Auto Repair):   

# of Units (Apartments)

Comments: 

Contact Information:

Please provide the following information so that we may contact you for any additional information.

Name:                    
       
Street Address:   
          
City:                                   

State:                         

Zip Code:              

Phone (day):         

Phone (night):       

email address:       

Best time to reach you:    

The Code Compliance Officer assigned to your case will contact you within 10 days.