Drainage & Foundation
Assessment Request

PROJECT / PROPERTY

Property Address:

City: State: -- AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:

OWNER / MANAGEMENT - CONTACT

Contact: Title:

Mgmt. Company If Any:

Direct Phone: E-mail:

GENERAL INFORMATION

Building Type: Select One Residential Retail Warehouse Office Condominium Building Apartment Complex Agricultural Manufacturing Other

Number of Buildings: Total Stories:

Inspection Needed by: Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2006 2007 2008 2009 2010

Year Built:

Type of Construction:

 Wood Frame     Poured Concrete    Steel    

Other:

Are there any previous studies or reports available
for review: - Yes No

Are There Any Known Drainage or Foundation
Issues with the Property/Comments:

Other Info you think we need to know.