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2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Date of Request
    Date of Request
14. Request for:

    1. Appeal of Code Officiation Interpretation
    2. Advisory Opinion
16. Relevant Codes

    1. Building Code
    2. Residential Code
    3. Mechanical Code
    4. Fuel Gas Code
    5. Plumbing Code

    1. Existing Building Code
    2. Energy Conservation Code
    3. Fire Code
    4. National Electrical Code
    5. Unknown
18. Section Numbers of Relevant Codes
20. Description
    Describe desired action by the board. Attach additional pages as desired.
22. Additional Description/Files
23. Requestor shall be notified of meeting date.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field