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| Client Information | Please provide as much information as possible. |
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| First Name:* | |
| Last Name:* | |
| Address: | |
| Address2: | |
| City: | |
| State, Zip: | |
| Home Phone: | |
| Work Phone: | |
| Cell Phone: | |
| Fax: | |
| Email: | |
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| Inspection Site Information | |
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| Address: | |
| Address2: | |
| City: | |
| State, Zip: | |
| Property Type: | |
| Age of Home: | |
| Total Sq. Footage: | |
| Heated Sq. Footage: | |
| Foundation: | |
| # of Bedrooms: | |
| # of Bathrooms: | |
| Occupied: | |
| Utilities: | |
| Inspection Date: (Requested) | |
| Inspection Time: (Requested) | |
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| Please include any additional information regarding the inspection site such as, in ground pool w/spa, waterfront w/seawall, detached garage or other structure, and also your realtors name and phone number | |
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| Notes/Comments: | |
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Copyright © 2002 Chaiban Engineering
Consultants, Inc.
Last modified: 07/28/05
Structural
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