HomeMy WebLinkAboutRecords Request - OTH Record Requests - 6/1/2009 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
Requestors name: Date:
Company Representing: Mail Fax Pickup View
Address: to 5 0 5 11 g /lam Phone:
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City,State, Zip: Fax:
Parcel (.�- Parcel Address:
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Owner: Previous owner:
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 ***
agree to pay all copy charges pursuant to Mason County's fee schedule.RCW 42.56-120
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:
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Completion date � I l r.,
Completed by Ex�:OZg 0
ee's due $ �.
Records were Mailed Faxed Viewed Picked up
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MASON COUNTY PUBLIC RECORDS REQUEST FORM
426 W Cedar St, PO BOX 186, Shelton WA 98584
PHONE(360)427-9670 FAX(360)427-7798
Please allow 5 business days for us to respond to your request*
If items are being mailed please allow an additional 3 days until you receive the paperwork
I would like the information: Requestor's Name
Mailed ❑ Faxed ❑ Picked Up- ❑ Address ut
Date of Request r�,2-t-0 ( City St Zip
Time of Request `-`4 C' ftW` Phone a37- -77 7 l Fax
PLEASE PROVIDE RE DS FOR THE FOLLOWING:
Septic Records As-Built Only ❑ 12 Digit Tax Parcel No.
Other (See Below) ❑ 3 2— 2 :3 _So - D O 6
Present Owner Legal Description
Previous Owner
Site Address (,2�p� *rft�'s P'erw_
Please specifically describe what records or kinds of records you are requesting:
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• RCW 42.17.020 I certify that the information obtained through this request will not be used for
commercial purposes.
Signature Date
• Large requests may be charged as provided by RCW 42.17.310. 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 per page. Copies can be mailed or you may pick them up when ready.
• Copies of blue prints or other large format items, when available, may be charged a higher rate
er a e
Official Use Only
Request Routed To: PAC File Clerk ❑ County Admin. ❑ Clerk of the Comm. ❑
Other ❑ Building ❑ Planning ❑ Environmental Health ❑
Public Works ❑ Assessor ❑ Auditor ❑ Treasurer ❑
Completed by: k4r{iv` Ext 5qi Records were
Completed date: 5- � -G7 Faxed [l-"'�
Notes: s�b�-r ��cor-�s t � 2 Mailed ❑
To be picked up ❑
Date Stamp:
°~ Col.. PUBLIC RECORDS REQUEST FORM
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Received By:
Name Phone2-C& %` ,l_Z
Address �f Y S � Fax
City, State.Zip mail
Record(s) requested: Please describe a specific identifiable record.'Include document name, number or date if known.
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❑ I would like to inspect the record(s)at no charge
1 would like a copy of the record(s): 0 Mailed 0 Faxed *Emalled(if available in electronic format) OPicked up
Please allow 5 business days for a response to your request. RCW 42.56.520 L7 t` i►c7 ��u�� �_
agree to pay all copy charges pursuant to Mason County's fee schedule. RCW 42.56.120 ° Pick up
I certify the informa6o ined through request will not be used for commercial purposes. RCW 42.56.070(9)
Requestor Signa re �� ' �'�"'� Date / 7(CZ
OFFICIAL USE ONLY
No responsive record was located.
The record is exempt from disclosure pursuant to RCW (attach exemption log)
❑ Portions of the record are exempt from disclosure and have been redacted pursuant to RCW
❑ Request forwarded to
5 day response Date
Number of pages Fees Due$ ❑ Payment received
Completed By: Date:
Records were: ❑ Mailed ❑ Faxed ❑ Emailed ❑ Picked up