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e�5 <br />� <br />SL a'i'�g. <br />COMPLAIn7 INVFSTI�^aATION REQUEST <br />(_�/ �� o % <br />�/ <br />DATE S � <br />VIOLATOR: <br />Nam,: <br />fi <br />Violation Address/Location: �/ - //S� �3� <br />City: (/�f'�Iv� Zip: / �� <br />No.: <br />Case No. �y' 337 .Y� <br />LZZ�1 <br />Snohomish County <br />Community Development <br />M/s a�io <br />3000 Rockefeller Avenue <br />— Everett, WA 98201 <br />(206) 388-3650 <br />1(800) 562-4367 <br />�$� <br />Tax Accow;; No. (il known): �.36 -OGD - 6.?4 � 0/09 <br />•••Under Chapter n2.17 R.C.W., the Public Uisciosure Law, you as complainant may indicate a preference for <br />dis.:losuro or non-ciisclosure of your name to inquiries trom the public. Please indicate by checking the appro- <br />p, iate box whother or not you wis' '� discloso your identiry regarding public inquiries into the comp�a�nt. <br />❑ You may disclose my identity upon pubiic <br />inquiries regarding this complalnt. <br />[� `fou may not disciose m r ldeNity <br />upon public inquiries regarding this <br />compla!nt without my permission. <br />•••it ;hould bo understood that A'ho case Is tiled in court, that your name must be disclosed if �ou aro to be a <br />w itness in the case. <br />COMPLAINANT: <br />Name� �w� `�/`Ond�Pirvti -- <br />Address: _! y — /�'t� G s� <br />"ic�nature of Complainant: <br />G451G-1 <br />Rev. B/33 <br />u.s. <br />� 3�-F-�J • �'�t(.��-.. <br />Home q: <br />Work N: � ✓ ��97 <br />City: �v � _ Zip:%�oZ�� <br />a �2_ <br />Date: � � 5 � � <br />