HomeMy WebLinkAboutBuilding Structure without Permits - BLD Letters / Memos - 10/6/2004 INVESTIGATION REPORT FORM
Revised01/22/03 C'/ IfZUf7
V
Part A: Nature of Complaint
• Initiator's Name:
• Address:
• Telephone:
• Owner Name: '
• Address:
• Telephone:
• Department of Concern
❑ Clerical -Building ❑ Health Comm Development ❑ Fire
• Area of Concern:
❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other
Refer to Director
• Location of Concern:
C) � .
• Site AddressqO O
• Nature of Concern:
r
• DOES COMPLAINTANT WANT TO REMAIN ANONYMOUS :❑'Yes ❑ No
Part B: Concern Intake and Referral
Received By: Referyed To: 9/Cr.C� Response Date:
Name Date Name Date Date 0
Part C: Findings y
Referral Forwarded to: /} / !� / e� ``f ❑N/A
Name Date
Findings: ,��i,4i i i
7—X)
Part D: Resolution
or-CEIVED
SEP 3 0 2004
Name l Date BELFAIR OFFICE
Intake Copy-White File Copy-Yellow