HomeMy WebLinkAboutRenting Space without Permits - BLD Letters / Memos - 1/29/2018 Case Number:�f
Mason County Investigation Report Form
Parcel Number: 3z3S _ �I __ Aso i'li; }}
Violation Site Address: <Z7Q,O ST_ /� 7 rf. �o� �liJ rorJ- I.0,t2gS72
Property Owner(s):Mick ArL -L Aa c,c 7 lqnj c f t- Phone#: 239-2 z.Z- l7/9
Mailing Address: '97V F, ST. 1?-T€- 16 6 d�io W', . �Z
Tenant/Contractor/Operator on site: r
Directions to Site: R i�)% j.Jr.25'u MASoN I A4_'&,P LcE7 T xrc-c �D
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Description of Concern: C/N T/!V
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Under the provisions of the Public Disclosure Law, RCW 42.56.240, the complainant may indicate a
desire for disclosure or non-disclosure of their identity. If non-disclosure is chosen, the bottom portion of
this form will not be released to the public unless this case is filed in count. Iffrled,your name will be
disclosed if you are a witness in the case.
Mason County investigates possible violations on a complaint basis only. Therefore,the name of the
person filing the complaint should be provided.
Please Check One Of The Following Lines:
Please do not disclose my identity. I understand that disclosure may be required by court
order or if this matter goes to court.
❑ You may disclose my identity.
Name(please print): _ Phone:( )
Address:_
Street City State Zip
Signature of Complainant: Date:
THIS SECTION FOR MASON COUNTY USE ONLY.
Complaint Received by(if applicable):
Complaint Received by: Phone Email Web Site In Person
Department of Concern: Building_ Planning_ Fire_ Public Works
Environmental Health: Solid_ On-site
Investigation Date and Findings:
i
Date Closed: -.Reason Closed: Initials