Fire Code Violation Appeal

Address of Violation(Required)

Street Address Address Line 2 City State ZIP Code

Appellant Name(Required)

First Last

Appellant Address(Required)

Street Address Address Line 2 City State ZIP Code

Name(Required)

First Last

Property Owner Address(Required)

Street Address Address Line 2 City State ZIP Code

Point of Contact Name(Required)

First Last

Point of Contact Phone(Required)

Point of Contact Email(Required)

Claim for Appeal:(Required)

The true intent of the Code has been incorrectly interpreted

The provisions of the Code do not fully apply

A decision is unreasonable or arbitrary as it applies to alternatives or new materials

select all that apply

Violations Under Appeal(Required)

List by violation code number

Justification as to the Applicability of the Claim(s) for Appeal(Required)

A Requested Remedy(Required)

Justification for the Requested Remedy(Required)

State specifically how the Code is complied with, public safety is secured, and fire fighter safety is secured