Inspection Request Form

Requester Information:
Requested By: Name / Company*
Requester Email*
Requester Phone*

Permit Information:
Permit Number*
Jobsite Street Address*
City/Township/Village*

Health & Safety:
Has anyone at the property indicated above been sick or in contact with someone sick in the last two weeks?* YesNo

Inspection Information:
Date Ready for Inspection*
Permit Type*

Building Inspection: Select Inspection Type:

Electrical Inspection: Select Inspection Type:

Mechanical Inspection: Select Inspection Type:

Plumbing Inspection: Select Inspection Type:

Other Inspection Type: Describe

Notes: Include any access instructions.

Site Contact Information:
Information is Same as Requester Information?* YesNo

Site Contact Name*
Site Contact Phone*

Affidavit:

I hereby certify that I am authorized to make this request on behalf of the permit applicant. I certify that all information is true and complete to the best of my knowledge. I understand that this form is used only to request an inspection, and does not mean that an inspection has actually been scheduled. I understand that if I do not receive a confirmation it is my responsibility to follow up and confirm that an inspection has been scheduled.

I have read, understood, and agree with the above statement.

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