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2. First Name*
3. Last Name*
4. Ticket Status
   -- Select One --OpenClosedPending
6. Department*
   -- Select One --Audit ServicesBudget & Management ServicesCity Attorney's OfficeCity Clerk's OfficeCity ManagerCity-County InspectionsCity-County PlanningCommunity DevelopmentEmergency CommunicationsEqual Opportunity/Equity AssuranceFinanceFire DepartmentFleet ManagementGeneral ServicesHuman ResourcesNeighborhood Improvement ServicesOffice of Economic & Workforce DevelopmentOffice of Public AffairsParks & RecreationPolice DepartmentPublic WorksSolid Waste ManagementTechnology SolutionsTransportationWater Management
7. Building Name or Address*
9. Description of Issue*
   Please be descriptive, but succinct. What impact does this issue present to your department? How many people does it impact?
10. Issue Category*
    -- Select One --Life Safety, Code Compliance, ADA Compliance, or Environmental HazardBuilding Roof and/or Envelope IntegrityBuilding Operational Systems and EquipmentBuilding FunctionalityOther
12. Have you requested deferred maintenance funding for this issue in past years?

    1. Yes
    2. No
13. How long has this issue been present?

    1. 0-6 months
    2. 6 months - 1 year
    3. 1-2 years
    4. 2-5 years
    5. More than 5 years
15. Photo of Issue*
17. Additional Information Related to Cost of Work (quote, assumptions, etc.)
    PDF's Only
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19. 1. Receive an email copy of this form.
20. Email address

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21. Submit

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