Wildfire Home Safety Evaluation

Thank you for your interest in having a Home Safety Evaluation by our Wildfire Mitigation Team.

The below listed individual grants permission for a Wildfire Mitigation Team member to conduct a Home Safety Evaluation on the property listed below:

Name (First and Last)

Street Address

City

State

Zip Code

I am the owner or tenant of this property

By providing my initials in this text box, I authorize the public use of the evaluation results, and understand that the evaluation will be conducted at no cost.

Date

Phone