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2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Email Address*
14. PROPERTY VIOLATION INFORMATION
15. Please enter the enforcement number ENF-*
17. Address of Property Violations*
19. Are you appealing the violations cited in the noted enforcement?*

    1. YES
    2. YES, PARTIALLY
21. Please indicate your reasons and/or concerns for appealing the code violations:*
23. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
25. Electronic Signature*
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field