request for service
Complete this form to request service for a code compliance issue. All information provided becomes a matter of public record and is available upon request.
For questions or comments: Phone: (321) 952-3430
Resident Name:
First Name:
Last Name:
Resident Information:
Street Number:
Street Name:
City/State: Palm Bay, Florida
Zip/Postal Code:
Home Phone: xxx-xxx-xxxx
Cell Phone: xxx-xxx-xxxx
Alternate Phone: xxx-xxx-xxxx
Address of Issue: (required field)
Description of Issue: (required field)
Contact Information: Code Compliance will contact you to follow-up on the issue if you so desire. Your contact information is also helpful to us as we may need additional information to assist us in processing your request.
All information provided becomes a matter of Public Record and is available upon request. Read Legal Disclaimer for additional information.
Contact E-mail Address:
^Top