City of Irvine Website - Resident Report Form

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Resident Report Form

Public Works Department
Resident Report Form

*Name:


*Address1:


*Address2:


*Phone (Home): Please remember your area code.


*Phone (Work): Please remember your area code.


*E-Mail: Please enter your email address so we can confirm the message.


The best time to contact me is between the hours of:


Please Contact me regarding:



Please describe the problem:



Location of the nearest cross street:

Please enter the word above in the text box below.

*Privacy Statement:

"The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, the personal information noted by an asterisk (*) on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals."