Graffiti Professional Cleaning Application
FOIP Statement
Your personal information is being collected under the Authority of Section 33 (c) of the Freedom of Information and
Protection of Privacy Act, and will be used to aid in maintaining accurate records, to provide contact information for the
program and to administer the Graffiti Management Program. It will be treated in accordance with the privacy
protection provisions of Part 2 of the Freedom of Information and Protection of Privacy Act. If you have any questions
about the collection, contact the Volunteer Coordinator, 2nd Floor, Beaufort Building, 10835 – 120 Street, Edmonton AB,
T5H 3P9 or (780) 496-8047.
* Required
Name of Applicant
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
On-site contact
If you are the onsite contact and your information is listed above, you do not need to fill this out.
Your answer
Address
*
Property where the graffiti is located.
Your answer
Business Name
If applicable
Your answer
Business Phone
If different then above
Your answer
Business email
If different then above
Your answer
Is this property a designated historic building?
*
Yes
No
Did you receive a notice from a City of Edmonton Bylaw Officer?
*
Yes
No
If Yes, include your bylaw reference number
Your answer
Is the property accessible?
*
Yes
No
If No, How do we gain access?
Your answer
Is the graffiti vandalism hate-related, graphic in nature, or derogatory?
*
Yes
No
Did you take photos of graffiti?
*
**All applications must include photos to be considered
Yes
No
Did you report the graffiti vandalism to EPS?
*
EPS file number is required for application to be considered
Yes
No
EPS file number
*
EPS file number is required for application to be considered. Report to EPS online at
http://www.edmontonpolice.ca/ContactEPS/OnlineCrimeReporting.aspx
Your answer
Description of location of graffiti on property
*
Example: north building side, east fence, garage, etc
Your answer
Type of surface
*
check all that apply
Raw Brick
Painted
Stucco
Concrete
Siding
Glass
Wood
Metal
Stone
Other:
Required
Are there any special cleaning requirements for your building?
Please explain
Your answer
Would you like to know more about anti-graffiti coatings?
*
Yes
No
Do you wish to receive emails from Capital City Clean Up which may contain commercial content (this could include information such as giveaways from our program partners)?
*
We will not share your email address outside of our organization.
Yes
No
By clicking the yes button and submitting the form, this constitutes signature agreeing to the above noted items.
*
Yes
No
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