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2. APPLICANT INFORMATION
4. Application Date*
   Application Date
5. Applicant Name*
6. Applicant Company (If Applicable)
8. Applicant Address*
10. City*
11. State*
12. Zip Code*
14. Mailing Address (If Different)
16. City
17. State
18. Zip Code
20. Applicant Email Address*
21. Applicant Phone Number*
23. REQUESTING PROPERTY INFORMATION
25. Include Permit Documentation and Violations for:*

    1. Building Code

    1. Electrical Code

    1. Mechanical Code

    1. Plumbing Code

    Check all that Apply
27. Record Request Legal Address*
28. Parcel Number
30. City*
31. State*
32. Zip Code*
34. Specify Specific Records/Documents and Special Instructions
36. Select One Option*

    1. Provide Records for Review
    2. Provide Copies of all Responsive Documents
37. Provide Copies of all Certificates of Occupancy for the Properties Indicated*

    1. Yes
    2. No
39. AUTHORIZATION
41. Authorizations*

    1. I Authorize the Department to Complete a Full Review of Records Pertaining to the Property Even if the Review Will Take Longer Than 2 Hours
    2. By Submitting This Application, I Agree to Pay all Applicable Fees, Including for Copying and Personnel Time, Prior to Receiving or Reviewing Documents From DILP.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field