Customer Action Request

2. Customer Action Request

3. 

5. IF YOU HAVE AN EMERGENCY, CALL 911.<br>The email account that receives this information is monitored during working hours.

   IF YOU HAVE AN EMERGENCY, CALL 911.
   The email account that receives this information is monitored during working hours.

7. When to use this form

   Use this form to report problems or request assistance for issues similar to those listed below. DO NOT USE THIS FORM TO CONTACT THE <a href="http://www.bothellwa.gov/QuickLinks.aspx?CID=110">POLICE</a>, REPORT <a href=" https://www.bothellwa.gov/FormCenter/Surface-Water-Management-6/Report-a-Drainage-Issue-147">DRAINAGE ISSUES</a>, REQUEST PARK <a href="http://www.bothellwa.gov/1196/Rental-Facilities">RESERVATIONS</a> OR REGISTER FOR RECREATION <a href="https://bluerec3.bluerec.com/php/onlinereg/#/bothellwa/login">PROGRAMS</a>. <br>Please check the item that most closely matches your request:

   Use this form to report problems or request assistance for issues similar to those listed below. DO NOT USE THIS FORM TO CONTACT THE POLICE, REPORT DRAINAGE ISSUES, REQUEST PARK RESERVATIONS OR REGISTER FOR RECREATION PROGRAMS.
   Please check the item that most closely matches your request:

9. Code Compliance Issues

   1. Nuisance Vehicles
   2. Overgrown Property
   3. Nuisance Property
   4. Building Code Violations
   5. Miscellaneous Code Violations

10. Parks

    1. Park/Field Conditions
    2. Bathrooms
    3. Vegetation
    4. Access

12. Public Works

    1. Potholes
    2. Overgrown Vegetation
    3. Street Lights
    4. Water
    5. Sewer
    6. Construction Projects

13. Street Concerns

    1. Traffic Signals
    2. Striping/pavement marking
    3. Crosswalks
    4. Flags
    5. Traffic Calming: Radar Speed Sign
    6. Street Sign
    7. Parking
    8. None of the above

15. Brief Description of Request*

17. File Upload

    If you would like to add a photo or document

19. Address, parcel number, or location of request:*

21. Enter your name here

22. How would you like us to contact you?*

    1. Call me
    2. Email me
    3. Do not contact me/I wish to remain anonymous

24. Phone number:

25. Email address:

27. We may not be able to process your request if we need more information but have no way to reach you.*

    1. I understand
29. Thanks for taking the time to report your concern.

    Thanks for taking the time to report your concern.

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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