HomeMy WebLinkAboutOTH Record Requests - 11/8/2010 MASON COUNTY PUBLIC RECORDS REQUEST FORM
426 W. Cedar Street, PO Box 186, Shelton WA 98584
PHONE (360) 427-9670 ext. 352 FAX (360) 427-7798
Reque r s name: l Date: I I I
Company epresenting: Mail Fax Pickup View
Address: 0 0 P� ( O _-) Phone: _8 3q
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City, State, ip: Fax:
Parcel #: � �1 — � Parcel Address:
Owner: Previous owner:
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Please provide records for the Following:
Environmental Health Planning Dept. Building Dept.
Please specifically describe what records you are requesting.
***Please allow 5 business days for a response to your request. RCW 42.56.520 ***
I agree to pay all copy charges pursuant to Mason County's fee schedule. RCW 42.56-120
I certify the information obtained through this request will not be used for commercial purposes.RCW 42.56-070(9)
Requestors Signature: Date:
Official Use Only
Five-day notice sent Date:
Completion date
Completed by Ext.:
ee's due $ —
Records were Mailed Faxed Viewed Picked up
Motes