| First name* |
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| Last name* |
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| E-Mail* |
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| City |
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| Year built |
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| Type de bâtiment |
Other : |
| Number of floors |
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| Material Type |
Bricks
Stones
Wood
Homogeneous
Heterogeneous
Unknown materials |
| Presence of moisture |
On the perimeter walls
On the front walls
On bearing walls
On interior walls
On all walls |
| Description |
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| Attach photos to a visual observation (maximum 3MB) |
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photo 1 :
photo 2 : |
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