HomeMy WebLinkAboutOTH Record Requests - 10/16/2013 MASON COUNTY PUBLIC RECORDS REQUEST FORM
426 W. Cedar Street, PO Bog 186, Shelton WA 98584
PHONE (360) 427-9670 ext.352 FAX (360) 427-7798
Requestors name: MI,ckae ( Ca3e Date:
Company Representing: Mail Fax Pickup View
Address: Phone:
,2040 wkecV� (�1� }�jn3 (9 0) 47q-Co:13(
City, State, Zip: Fax:
brew«,k�ti, WA. q83 rC�
Parcel#: ,Z,23z5-5� U3UZS�2�+/23 Parcel Address:
(91/ A/c /�?,S3iavt Crk kd (3QcFcur
Owner: Previous owner:
Please provide records for the Following:
Planning Dept. Building Dept.
Please specifically describe what records you are requesting.
All o �S
***Please allow 5 business days for a response to your request. RCW 42.56.520 ***
I 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: 0/1.6 /9013
Offccial Use Only
Five-day notice sent Date:
Completion date
Completed by G 1(.Q J Ext.:
ee's due $
Records were Mailed Faxed Viewed Picked up
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