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2. For requesting results of a Fire Inspection conducted in the city of Winston-Salem.
4. First Name*
5. Last Name*
7. Phone Number*
9. Email Address*
13. Date inspection took place*
    Date inspection took place
15. Address*
17. City*
21. Method to receive report*
    -- Select One --EmailFaxPickup Report (Inspector will inform when report is ready)
22. Fax Number*
24. You will be notified using the method noted when your Inspection Report is ready.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field