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NOTICE OF DISAGREEMENT AND REQUEST FOR ADMINSTRATIVE HEARING NOTICE OF CODE VIOLATION (ABATEMENT/CIVIL PENALTIES), IMPOSITION OF CIVIL PENALTY OR BILLING I, , the owner/ authorized agent, do hereby disagree with the determination or action of an inspection/abatement and wish to appeal the following notice or billing (a copy of which is attached): Case Number (only one case per application) Property Address, as it appears on the notice or citation Notice of Code Violation Notice of Civil Citation Abatement (notice or invoice) I hereby request a hearing before the Hearing Officer for the following reasons: Current STREET address where ALL correspondence pursuant to this appeal will be sent Daytime telephone number Cell phone number Date Signature By dating, signing, and paying the filing fee for the appeal hearing, you are agreeing to be in attendance at the scheduled hearing and that you have received a copy of this form. Please make every effort to attend your scheduled hearing, as a decision will be rendered whether you or your authorized agent are present. If you are not able to attend in person a phone hearing may be scheduled. Appeal Hearings are held at the Ogden City Justice Court, located at 310 26 th Street and begin at 5:00 p.m. Your hearing is scheduled for: This form and information contained herein is a public document. The completed form must be filed within 10 calendar days from the date of the notice or citation and must be filed in the Office of the City Recorder, 2549 Washington Boulevard, Suite 210, Ogden, Utah, Monday through Friday, from 8:00 a.m. and 5:00 p.m. There is a 25.00 non-refundable filing fee required to file this appeal. It is encouraged that the appellant contact the Code Enforcement office in person or call [PHONE REDACTED] before the appeal is scheduled. Office Use Only Original to Code Enforcement Copy filed in the Office of the City Recorder