POLICE DEPARTMENT 10500 47
TH
Place West MUKILTEO, WASHINGTON 98275
Telephone (425) 263-8100
VACATION WATCH REQUEST
This free service is provided primarily by police department officers and/or volunteers and they are done solely to the extent that time and
personnel are available. As a courtesy, the Mukilteo Police Department will provide this service for
a maximum of 3 weeks.
Name:__________________________________________________
Address:________________________________________________
Home Phone:____________________________________________ Work/Cell Phone:______________________________
Date(s) house will be vacant: From:_____/____/____ To:_____/____/____
Is there a phone number you can be reached at in your absence:__________________________________________________
Local Emergency contact: Name:______________________________________ Phone:_____________________________
Address:____________________________________ Do they have keys ___ Yes ___ No
Please list any potential hazards:__________________________________________________________________________
Are there any cars that will be parked in the driveway: ___ Yes ___ No
If yes, please give make/model/color/license:_________________________________________________________
_________________________________________________________
Do you expect any people to be coming/going from the house (i.e. cleaners, contractors, pet sitters) ___ Yes ___ No
If yes, please describe:___________________________________________________________________________
Is there anyone specifically who should not be at your home: ___ Yes ___ No
If yes, please name:_____________________________________________________________________________
Do you have an alarm: ___ Yes ___ No Name of company:_______________________ Phone:____________________
Security Check Log
Date Time Name Notes
I hereby agree to save harmless the City of Mukilteo, the Mayor, the Chief of Police, all Police Officers and all employees of the City of
Mukilteo for any and all claims for personal injury, loss or damage to property that may be suffered by the undersigned through any action
or lack thereof by a representative of the City of Mukilteo. Further, the undersigned understands and agrees that this service does not create
a special duty upon the City and will be provided only as time is available, and no guarantee is made nor assurance given against loss, theft
or damage to premises.
Signed this _____ day of __________, 20___
By:____________________________________________
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome