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Public Nuisance Complaint Form

2. Name*

   Complaintant Name

4. Confidential Complaint*

   1. Yes
   2. No

6. Complainant Address

8. Street Number

9. Street Name

10. Street Type

11. Apt #

13. City

14. State

15. Zip

17. Phone Number

18. Email

20. Nuisance Category (Select all that apply)*

    1. Sanitary / Health Hazard
    2. Filth / Litter ? Debris / Storage
    3. Junk Vehicle(s) / Parking of Vehicles
    4. Graffiti

    1. Vegetation / Tree(s) shrubs
    2. Right-of-way obstruction
    3. Light trespass / Noise
    4. Interference or damage to Environmentally Sensitive Areas (i.e. bluffs, ravines, wetlands, streams, ect.)

    1. Abandoned / dilapidated structure
    2. Construction Nuisance
    3. Unauthorized / Illegal Sign
    4. Other (Please explain below)

22. Other Nuisance

24. Nuisance Address*

26. Nuisance Description

28. I understand that all public nuisance complaints are prioritized according to the level of adverse impact to public health, safety, and welfare; and that by checking the “confidential” box, I understand that confidentiality, or non-disclosure, relates to Public Records disclosure (RCW 42.56.24) and does not protect my identity in the event of court actions or proceedings.

    I understand that all public nuisance complaints are prioritized according to the level of adverse impact to public health, safety, and welfare; and that by checking the “confidential” box, I understand that confidentiality, or non-disclosure, relates to Public Records disclosure (RCW 42.56.24) and does not protect my identity in the event of court actions or proceedings.

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

    This field is not part of the form submission.

32. Submit

* indicates a required field