Storm Damage Report Parcel No.:*Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Have you been displaced due to a natural disaster? Yes No Have you filed for assistance with FEMA Yes No Is there signs of mold or mildew forming in your home? Yes No Did you have water intrusion to your home? Yes No Do you believe your home is uninhabitable? Yes No If you believe your home is uninhabitable, do you plan to rebuild or demolish the structure? Yes No Would you like the Building Inspector to contact you? Yes No Have you pulled any permits for reconstruction or repairs? Yes No Do you believe you will have your home fully repaired by January 1, 2018? Yes No If not, what is your estimated completion date? Month Day Year Did you have any exterior water damage? Yes No What level do you believe is your assessed damage:Affected is considered the lowest level, and destroyed is the highest level. Affected Minor Major Destroyed (Optional) You may also upload images of your property damage. Please note that there is a limit of 3 images. Drop files here or Select files Max. file size: 5 MB, Max. files: 3. If you have not applied for FEMA Assistance please follow this link: https://www.disasterassistance.gov Δ
