Fillable ADA Pedestrian Accessibility Improvement Request (City of Sumner)

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ADA Pedestrian Accessibility Improvement Request (City of Sumner)

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The ADA Pedestrian Accessibility Improvement Request (City of Sumner) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for City of Sumner

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Pedestrian Accessibility Improvement Request
Contact Informaon
Name: __________________________________________________________
Company: __________________________________________________________
Address: __________________________________________________________
City: _______________________________________ Zip: _____________
E-mail: __________________________________________________________
Phone: __________________________________________________________
Preferred
Contact Method:
mMail
mE-mail
mPhone
Barrier/Obstacle Informaon
Address: ____________________________ City: __________ Zip: ________
OR
Street: ____________________________ City: __________ Zip: ________
Cross Street: ____________________________ City: __________ Zip: ________
Facility Type
mCurb ramp
mCrosswalk
mDriveway approach
mSidewalk
mSignal
mBus stop
mWork zone
mRailroad crossing
mOther
______________________
Category
mMissing facility
mSteep slope
mInsucient dimensions
mInsucient markings
mTripping hazards
mSidewalk gaps/cracks
mOther
______________________
Descripon (include as much detail as possible regarding the barrier/obstacle):
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Print a copy of this request for your files and e-mail it to derekb@sumnerwa.gov, or mail it to: City of Sumner, ADA
Coordinator-Derek Barry, 1104 Maple Street, Sumner, WA 98390. You will be notified within 5 business days that your
request was received, and learn the outcome of the request within 15 business days. Questions? Please call 253-299-5714
(TTY: 711).
Diagram
Please indicate on the
diagram the general area
of the barrier/obstacle.
Street
Cross
Street
Street
Cross
Street
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ADA Pedestrian Accessibility Improvement Request (City of Sumner)

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Completed 25 July 2020

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