Buildings

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Name*

First Last

Email*

Phone

Address for Property of Concern

Street Address Address Line 2 City State ZIP Code

Is the building hazardous?

Yes

No

What is the issue?

(Note – multiple can be selected)

Electrical

Structural

Plumbing

Is the building vacant?

Yes

No

Please explain the situation to the best of your ability:*

Photo if available

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