City of Irvine Website - Resident Report Form

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	PUBLIC WORKS
	RESIDENT REQUEST FORM

Thank you for taking the time to submit your request utilizing the City of Irvine's Public Works Department Resident Report Form. The information you provide will be promptly forwarded to the appropriate city services. You may also reach us directly at (949) 724-7600.

NOTE: Fields highlighted in YELLOW are required.

C O N T A C T I N F O R M A T I O N
NAME*

ADDRESS 1*

ADDRESS 2*

HOME PHONE* OR	WORK PHONE*

EMAIL ADDRESS*

PLEASE ENTER THE BEST HOURS TO CONTACT YOU BETWEEN

R E P O R T I N F O R M A T I O N
TYPE OF ISSUE

PLEASE DESCRIBE THE ISSUE BELOW

LOCATION OF THE NEAREST CROSS STREET




Please enter the word above in the text box below.


The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, the personal information noted by an asterisk (*) on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals.