Citizen Action Request

CITIZEN ACTION REQUEST

REQUEST TAKEN VIA: Phone ____ Voicemail ____ Email ____ Observed ____ In-person ____ Fax ____

Name of Reporting Party: ______Address of Reporting Party: ______Phone Number: ______(Work ___Home___ Cell___) Email Address: ______

IF NECESSARY, MAY WE HAVE PERMISSION TO ENTER YORUR PROPERTY TO VIEW THE SUBJECT VIOLATION/CONDITION? Yes ______No ______

Confidentiality Preference: Information revealing the identity of persons who are witnesses to or victims of a crime, or who file complaints with the City, is exempt from public disclosure, if disclosure would endanger any person’s life, physical safety or property (RCW 42.56.240(2)). PLEASE INDICATE YOUR DESIRE FOR DISCLOSURE OR NON-DISCLOSURE OF YOUR IDENTITY BY CHECKING THE APPROPRIATE BOX, AND SIGN AND DATE BELOW. Such desire shall govern subject to application of the Public Disclosure Law, other applicable laws and whether the complaint is criminally prosecuted.

My identity can be disclosed ______Do not disclose my identity. ______

SIGNATURE ______DATE ______

NATURE OF VIOLATION OR CONDITION (Attach supplemental documentation if appropriate): ______ADDRESS OR LOCATION OF THE VIOLATION/CONDITION: ______WHEN THE CONDITION WAS NOTED? HOW LONG HAS THE CONDITION EXISTED? ______

Name(s) of Person(s) involved: Address Phone Number

Action Taken (To be Completed by Responding City Department) What corrective measures were taken or assistance given? If none, explain.

COMPLETED BY: DEPT. DATE: Procedure:

This form is used for intake of complaints from citizens or other agencies related to code violations or conditions of concern for the Public Works Department.

The Clerk will keep the original of the CAR, and will maintain a log of all CARs received.

The person/department responsible will get a copy and turn it back in to the clerk’s office with notes on how the complaint was resolved.

If the CAR is likely to cause issues that the mayor or city council should be aware of, give a copy of the CAR to the mayor.

If the condition is life-threatening, call 9-1-1.