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Depa�tment of Planning and Community Development <br /> Community Development Dlvision Case No. <br /> 4th Floor,Snohomish County Administration Building C•4510-t <br /> Everett,Washington 98201 Rev.B/e8 <br /> COMPLAINT INVESTIGATION REQUEST <br /> VIOLATOR: DATE: ` '_�T_ � ��� `C� <br /> Neme:S]�f ���/�� Phone No: ���'�-5 <br /> Address: <br /> y� �1� -�qd�s w s��� 103 ���y: 1��.��p: <br /> Vioietion�ocat�on:o�L/.�I'? ' (�/�y��5 l.(7fy'Yi.TJ` , LJ� �d�t�� <br /> City ' Zip <br /> Tax Account No.(if known): <br /> _� � � <br /> DETAILS OF COMPLAINT: ` <br /> t <br /> � � � <br /> �' ��_ _ <br /> � � � i��' �O C�GI� . 1 � I�'[.C.drG �- <br /> .-� <br /> 4 � <br /> �`Under Chapter 42.17 R.C.W.,the Public Disclosure Lew,you as complainant may Indicate a preference f or disclosure or <br /> non-disclosure of your name to inqufries.from the public. <br /> Please Indicate by checking the eppropriate box whether or not you wish to disclose your ldentity regardinp public inqulriea <br /> Into this complaint. <br /> ❑ You may disclose my identity upon public inquiries � You may not disclose my Identity upon public in- <br /> regarding this complaint. fnquirfes reyardinp this complaint without my <br /> permission. <br /> �'•It should be undantood thet if the casa is filed In eouK,that your nema must be dlaclosed if you �ro to bs a <br /> wltnsss In the case. <br /> COMPLAINANT: Home#: �S�� �'�f I .��� <br /> Name: �-��)n � ��� Work#: <br /> Address:_������Y] J� Clty: �Zip: `7Q�Dl <br /> ,, /�j <br /> Signature of Complainant: � � Date• �- ` `- -� <br /> LD�5� <br />