City of Kenmore
Community Development
6700 NE 181st Street
Kenmore, WA 98028
Phone (425) 296-5020

HOUSE CHECK REQUEST

 

Date/Time Received: Precinct: District :
Requestor: Phone Number:
Address:
Start Date/Time:
End Date/Time: 
Will someone be looking after the house?  
 
Y
N
 Name:
Phone:
Will anyone be given keys or access to house during your absence?
 
Y
N
 Name:
Phone:
Will any lights be left on?  
 
Y
N
 What Rooms?
If on timers, when?
Paper and mail stopped?
 
Y
N
  
Will any vehicles be left on property?
 
 
Y
N
 Year/Make:
Model:
      Year/Make:
Model:
Is a burglar alarm installed?  
 
Y
N
Silent:
Visual:
Audible:
 
How is it activated?  
      Sound:
Light Beams:
Contacts:
Other:
 
Which alarm company, or who should be contacted if alarm is activated?
      Name:
Phone:
Is there someone local we could contact in an emergency?
 
Y
N
 Name:
Phone:
Will there be a dog in the yard?
 
Y
N
 Describe:
Can you be reached in case of an emergency?
 
Y
N
 How/Where?
Remarks:
 

I do hereby grant and request the City of Kenmore Police Department Office to visually and physically check upon the property listed above. I understand that this free service does not create a special duty upon the City or its Police Department, and is provided only as time is available. I understand that no guarantee is made nor assurance given against loss, theft or damage to the premises or property. I agree to hold harmless the City of Kenmore Police Department's Office, and all thier respeitive staff and employees for any and all claims for personal injury, loss or damage to property, that may be suffered by me through any action or lack thereof by a representative of the City of Kenmore Police Department's Office.

Signed this __________________day of _________________________, 2003.

By: __________________________________ Print Name: ______________________________

Request taken by: _______________________ Serial #: ______________________