Public Works Department of Roeland Park
Public Works Service Request Form

Thank you for filling out our Public Works Service Request Form. Please provide 
as much information as possible to expedite service.  We will make every effort 
to respond to all work requests in a timely fashion.  

Your Contact Information  (All fields are required.)

First Name: _____________________________________________________________

Last Name: _____________________________________________________________

Email: _________________________________________________________________

Address: __________________________________________________________________ 

City: ______________ State: _____ Zip code: ___________

Daytime Phone: __________________________________________________________

Work Location
Closest Street Number (e.g. 51st Street): 
______________________________________________________________________________

Closest Street Name (e.g. Birch): 
_______________________________________________________________________________

General Location and/or street address: Please try to describe the general 
location of the issue (which side of street (north, south, east, west), major 
intersections (e.g., 55th and Nall):

_______________________________________________________________________________

Please describe the Service request (e.g. drainage inlet not working on east 
side of street; or damaged curb at the corner of 49th St. and Nall.)
_______________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

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Public Works Department of Roeland Park
4600 West 51st Street
Roeland Park, KS 66205
fax: 913-236-4337