HomeMy WebLinkAboutRecords Request - OTH Record Requests - 8/3/2007 c
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G ' Mason County Public Records Request Form
1 426 W. Cedar Street, PO Box 186, Shelton WA. 98584
Phone: 360 427-9670 X-352 Fax: 360 427-7798
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I would like information: Mailed Faxed Picked Up Date:
Requesters Name:
Company Representing:
Address: y f �� P/ ✓� $ Email:
City: UP / a/1 State:W14 Zip:
Phone: 4&I B 77- 9 6 7 Fax:
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Parcel No. .� 3
Parcel Address: �// ��/"
Owner: l4 / G f S Previous Owner J-e,, �r Cc
Please Provide Records For The Following:
Environmental Health C Planning Dept. x Building Dept. X
Please specifically describe what records or kind of records you are requesting:
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RCW 42.56 I certify that the information obtained,from this request will not be used for
commercial purposes. Signature Required:
Requests maybe charged per RCW 42.56. During file review any pages you wish to
have copied( excluding non public record documents)must be tagged and charges will
be assessed at .15 cents per copy. Larger than 8.5"x 11"will be charged at a higher rate A
as established by Mason County resolution.
In addition to the per copied page fee standard postage rates will apply. c�
Make Checks Payable To: Mason County Treasurer; Total Fees Due:
Official Use Only
/l Completed By: Ext. Date:
Notes: '
*Please allow 5/business days for us to respond to y ur request*
�1l If items are being mailed please allow an additional 3 dAysuntil you receive the request sublmi"ed�.,Q ,�
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