2. Property ID*
4. Address1
6. Address2
8. City
9. State
10. Zip
14. Number of Stories
15. Date of Construction
17. Walls
    -- Select One --Wood FrameSteelConcreteMasonryManufactured HomeModular HousingOther
18. If other:
20. Elevated (number of steps to front door):
22. Foundation Type
    -- Select One --Slab-On-GradePiers, Posts, Piles, Columns, Parallel Shear WallsPiers, Posts, Piles, Columns, Parallel Shear Walls (full or partial enclosureElevated Foundation WallsElevated Foundation Walls (full or partial enclosure)
24. HVAC
    -- Select One --Elevated to Base Flood ElevationNot Elevated (at grade or minimal difference)Elevated to First FloorElevated Above First FloorWindow UnitOther
25. If other:
29. First Name
30. Last Name
32. Phone
33. Please contact me

    1. yes
35. E-mail address
37. Additional Comments
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39. 1. Receive an email copy of this form.
40. Email address

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41. Submit

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