Resident Name:

First Name:

Last Name:

Resident Information:

Street Number:

Street Name:

City/State: Palm Bay, Florida

Zip/Postal Code:

Home Phone: xxx-xxx-xxxx

Cell Phone: xxx-xxx-xxxx

Alternate Phone: xxx-xxx-xxxx

Reporting an issue with the following: (check all that apply)
Pothole Repair
Sign Repairs (for Stop Signs call 321-952-3437)
Swale Trenching Request
Street Light Request
Street Sweeping
Nuisance Vegetation
Sidewalk Repair
Canal Mowing
Construction Project in Progress
Roadside and Median Maintenance

To report a power outage or problem contact FPL directly.

To report a problem with your trash or debris pick up contact Waste Management directly at 321-723-4455.

Description of Issue: (required field)

Exact Location of issue:

Other areas of concern:

Contact Information: (required field)
Public Works will contact you to follow-up on the issue, or to ask additional questions to assist us in processing your request.

All information provided becomes a matter of Public Record and is available upon request. Read Legal Disclaimer for additional information.

Contact E-mail Address: