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Request for Housing Quality Standards Inspection

  1. NON-PROFIT AGENCY INFORMATION

  2. HOUSING UNIT INFORMATION

  3. Additional Comments

  4. Please check the one that applies; comments may be added below:

  5. FOR PIERCE COUNTY COMMUNITY CONNECTIONS INTERNAL USE ONLY

  6. Inspection Type

  7. ___ New

  8. ___ Annual

  9. Year Built

  10. Type

  11. ___ SFR

  12. ___ 1-4

  13. ___ 5+

  14. Referred To

  15. ___ Arnold Nufer

  16. ___ Rand Bullinger

  17. Date of Referral

  18. Deadline Date

  19. Date Unit Passed Inspection

  20. After you click Submit, please allow a few seconds for your request to process, at which time you will be redirected to a confirmation page. Do not click Submit again.

  21. Leave This Blank:

  22. This field is not part of the form submission.