HomeMy WebLinkAboutIncorrectly Sided Home without Permit - BLD Letters / Memos - 4/15/2015 ti
Case Number: j5- ��
Mason County Investigation Report Form
Parcel Number: 12330 -51, - 00 0 ger&o
Violation Site Add;&J:, n I N )',/�NC KP- ll0
Property Owner(s): U'J tea ( �-� C Phone#:
Mailing Address:90 INto Lj a g(j s74)
Tenant/Contractor/Operator on site:
Directions to Site: _._SdAJ
I ..._.t� 1 r�/,Lt .0... ... .............. -
Description of Concern: ......__.....______._..
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, this portion of this form will
not be released to the public unless this case is filed in court. If filed,your name will be disclosed ifyou 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:
❑ 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: Date: 5 _
Complaint Received by: *hone ❑ Email ❑ Web Site ❑ In Person
Department of Concern: -1milding ❑ Planning ❑ Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other
Investigation Date and Findings:
Date Clos C Reason Closed: l��-� `- 2 ,Initia
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