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NOTICE OF DISAGREEMENT AND REQUEST FOR ADMINISTRATIVE HEARING NOTICE OF CODE VIOLATION (ABATEMENT/CIVIL PENALTIES), IMPOSITION OF CIVIL PENALTY OR BILLING X:\Recorder\Cassie's Folder\Nuisance Hearings\NOTICE OF DISAGREEMENT- zoning.doc 05/18/06 I, (please print name) do hereby disagree with the determination or action of the an Inspector within the Building Services Division and wish to appeal the following notice or billing (a copy of which must be attached) for property located at □ Notice of Code Violation □ Notice of Civil Penalty □ Invoice (City costs of Abatement) I hereby request a hearing before the Hearing Officer for the following reasons: Date Signature Address (where all notices pursuant to this appeal will be sent – no P.O. Boxes please) Daytime telephone # Cell phone # $25.00 filing fee paid □ receipt # OFFICE USE ONLY – Do Not Write Below This Line Date received: Time: By: Copies to: Hearing Officer Andy Blackburn Building Inspector Michael McDonald Inspector: Jeff Glum Bob Porter Gordon Sant Tim Johnson Trevor Anderson Sean Santoro Parking Violations Officer - Deb Jones (if appeal of civil penalty) City Treasurer, Mike Goodwin (if invoice) Fleet & Facilities Manager, Richard Brookins Date Copies Provided: This form and information contained herein is a public document. The completed form must be filed within ten (10 days) from either the date of mailing or the date of personal service of the notice, and must be filed in the Office of the City Recorder, 2549 Washington Boulevard, Suite 210, Ogden, Utah, Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m.