2. This form is for internal purposes only. Please report life or property threatening emergencies to 911. If you are a citizen of Bremerton or reporting a non-emergency issue, please call 360-473-5920 or e-mail Bremerton1@ci.bremerton.wa.us.
4. Requested By*
5. Phone Number
6. Project Number
   (If Known)
8. Division/Department Requesting Work From
   -- Select One --PW&U AdministrationPW&U ElectronicsPW&U EngineeringPW&U Equipment ServicesPW&U ForestryPW&U Inventory/FacilitiesPW&U Sewer/StormPW&U StreetsPW&U Traffic MaintenancePW&U Traffic SignalsPW&U Utility BillingPW&U Wastewater Treatment PlanPW&U Water Distribution PW&U Water ResourcesCity AttorneyCommunity DevelopmentFireHuman ResourcesMunicipal CourtPoliceParks & RecreationOther
9. Other
11. Location
    -- Select One --PW&U Facility, 100 Oyster Bay AvenueUtilities Building, 3027 Olympus DrivePolice Facility, 1025 Burwell StreetSOG Facility, 3029 Olympus DriveBremerton Library, 612 5th StreetFire Station #1, 911 Park AvenueFire Station #2, 5005 Kitsap WayFire Station #3, 3031 Olympus DriveFire Station Warehouse, 3033 Olympus DriveConference Center, 100 Washington AvenueDowntown Parking Facility, 405 Washington AvenueHarborside Parking Facility, 100 Washington AvenueGovernment Center, 345 6th StreetMunicipal Court, 550 Park AvenueNaval Museum, 251 1st StreetPark Avenue Plaza Garage, 300 Park AvenueOther
12. Other
14. Description of Work Requested*
16. Due Date
    Due Date
17. Requested Priority

    1. Emergency

    1. High

    1. Routine
19. Attach File
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field