Kitsap County Damage Report (Private Property Damage)

Please fill out the following, then click the submit button at the bottom of the page:

Name:
Home phone:
Work phone:
Cell phone:
Street address:
City:
State:
Zip code:
Email address:
Fax:
Describe your damage, (please be brief):
Is your home habitable?
Yes
No
Is your home accessible?
Yes
No
If no, where are you living?
Do you own or rent?
Own
Rent
Is this your primary or secondary residence?
Primary
Secondary
If this property is a rental, are you the landlord?
Yes
No
Does not apply
Was damage due to:
Wind
Rain
Flood
What type of property is it?
Private residence
Rental home
Mobile home
Business
Farm
Other?
If other, please describe:
Fair market value of home?
Do you have flood insurance:?
Yes
No
Unsure
If yes, who is your insurance company?
Insurance deductible:
Estimated dollar amount of structural damage:
Estimated dollar amount of personal property damage:
Vehicle damaged?
Yes
No
If yes, what is the insurance deductible?
Tax assessment number:
Miscellaneous:
Inspection needed?
Yes
No
Comments:

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