HomeMy WebLinkAboutDeck Being Built without Permits - BLD Letters / Memos - 8/5/2016 Case Number:r-KI rzA 1 (0 -uo 1 Z
Mason County Investigation Report Form
Parcel Number: 2-2- ZS ,-I' -C- DO s
Violation Site Address: I�I �t Qeatap�buO L.N1 9;E1.Fnri(2—
Property Owner(s): uLk A. Phone#:
Mailing Address: _12 INfe, �2 N'% L t4 q8�7Z 2)
Tenant/Contractor/Operator on site: r by-►6�r c_AL
Directions to Site: EO U ow (jq-Z>-W lie.-30 O W k v%� Pie. giti ✓, 1-�;l 1 a LZ> UDC' -300 Vj
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Description of Concern: i '\\8% 0 on - (7
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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, 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 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:
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): ► 1) r'DAD n Phone: � )
Address:
Street City State Zip
Signature of Complainant: Date:
THIS SECTION FOR MASON COUNTY USE ONLY
Complaint Received by: AV-i 5S o'_ Date:
Complaint Received by: 5.Phone ❑ Email ❑ Web Site ❑ In Person
Department of Concern: R Buiilding ❑ Planning ❑ Fire ❑ Public Works
Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other
Investigation Date and Findings: o. 6 _IvIG ��,,; . L'��K 5 (c S S -Ia-yK
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Date Closed Reason Closed: 00 U t_o(r, +c d initials: ��