Laserfiche WebLink
c !" I -7 -cici 5-- <br /> 2 <br /> Code Violation Complaint Form <br /> City of Anacortes Building Department <br /> 904 6th Street-Anacortes,Washington <br /> Phone: (360) 293-1901 Fax: (360) 293-1938trit tA. atk ak- l' i:. , : :,.:1 A a •- 4,r <br /> LITLATICh USE <br /> Please complete all applicable information and return to the above address. You will be contacted if additional <br /> information is required. Response time will vary according to the workload. Provide as many relevant details <br /> as possible including the specific address. <br /> Nature of Complaint: i 4.r + 4, ;1—.X .4#; <br /> d ,? Ai <br /> F't.,c_e utou_..... :_ L,, — 64--Ali.-- 6"c(14. 30--- , f ettO Lo -'-e-t_ e , <br /> uo cr--) e-)2__1' _g_. _,.e ._,rck <br /> Location of Complaint(street address): i i 10' _ <br /> Occupant/Resident: Owner Name:__CL4ft„Lav 12 ��. <br /> Home Phone: Address:_ _ , s' <br /> -k-di <br /> Work Phone: City:�c. - � w4 C. - <br /> Person Issuing Complaint <br /> _AtYour NamL ,, rek..10Address: 6 N-e-i <br /> Your Home Phone Number: Work or Cell Number: B t -_.- ,'- / is <br /> Disclosure of information revealing your identify will depend on application of the public disclosure law, Chapter 42.17 <br /> RCW, other applicable statues and whether the complaint is criminally or civilly prosecuted. When giving your name you <br /> may request that the Department not release your identity in connection with the investigation (you should be aware, <br /> however, that if enforcement action results in court or hearing examiner proceedings, it may not be possible to keep your <br /> name confidential). <br /> Signature: \al. t• Date: , - f"j - j: 1 <br /> For Official Use Only <br /> Date Received: / /! 7 Received By: �-it-- <br /> • <br /> Additional Information: ' 4 fLet .^. I,' I rP4 e ,h '}- <br /> Referred to: Police Engineering Parks Sanitation Fire Streets Water Other <br /> Date Referred: <br />