Request For Review Of Charge Form - Safebult Code Enforcement Department - City Of Muskegon
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2CITY OF MUSKEGON/SAFEBUILT
CODE ENFORCEMENT DEPT.
REQUEST FOR REVIEW OF CHARGE
PROPERTY ADDRESS______________________________________INVOICE# ______________
TYPE OF CHARGE BEING APPEALED: MOWING ___
TRASH CLEAN-UP ___
24-HR TERRACE ___
YOUR NAME_________________________________________
PHONE _______________________
ADDRESS
_________________________________________
APPEAL DATE __________________
CITY
_________________________________________
INVOICE DATE__________________
REASON FOR DISPUTE (be specific)______________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
-----------------------------------------------FOR OFFICE USE ONLY BELOW THIS LINE------------------------------------------------
*ORIGINAL INSPECTOR NEEDS TO COMPLETE INSPECTOR'S COMMENT SECTION
INSPECTOR’S FINDINGS: ENFORCEMENT #______________
DATE LETTER SENT______________________
DATE OF W. O.________________CONTRACTOR________
DATE OF SERVICE_______________________
*INSPECTOR'S COMMENT_____________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
DECISION
===================================================================================
DATE ________________ INSPECTOR_________________
____ Void ____ Valid ____Reduce
___________________________________________________________________________________________
___________________________________________________________________________________________
CHARGEBACK CONTRACTOR? NO ____ YES _____ CONTRACTOR NAME:___________AMOUNT?_____________
==============================================================================================
SUPERVISOR’S ACTION: DATE_______________SIGNATURE___________________________________________
_____________________________________________________________________________
_________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
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