Accessibility Request Form

2. This form allows residents and businesses to submit accessibility requests related to a wide variety of issues, including curb ramps, sidewalk obstructions and access to buildings, facilities or programs. The form will be reviewed by the ADA Coordinator and a response will be provided via email. To report a situation that may endanger pedestrians or bicyclists, please contact Public Works and Utilities Customer Response at 360-473-5920.
   Please provide as much information about your accessibility request as possible. The more information provided, the better we can serve you.

   Please provide as much information about your accessibility request as possible. The more information provided, the better we can serve you.

6. Type of Accessibility or Accommodation Request*

   1. Curb Ramp
   2. Sidewalk
   3. Facility
   4. Obstruction
   5. Trip Hazard

   1. Signage
   2. Signal
   3. Park Facility or Program
   4. Other

7. Type of Request

9. Problem Address

11. Street Address*

    (enter none if unknown or not applicable)

12. Cross Street

14. Describe Problem*

16. Requester Information

18. First Name*

19. Last Name*

21. Company Name

    (if applicable)

22. Address*

24. City*

25. State*

26. Zip*

28. Telephone*

29. Email Address*

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

* indicates a required field