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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Phone Number*
    Please provide a phone number where you can be most easily reached.
14. Email
18. Description of Code Violation*
    Please describe the code violation you are reporting. Include as much detail as possible so that Department of Planning staff can fully address the issue.
19. Attach An Image
    Please attach an image of the reported violation if available.
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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