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1.TYO <br /> Cr fh COMPLAINT INVESTIGATION REQUEST <br /> 9QORS� <br /> Instructions: To initiate an investigation, completely fill out this form, sign and date it,and submit to <br /> City of Anacortes,Attn.: Building Department, 904 6th Street, Anacortes, WA 98221 <br /> Address or Location of Problem: � ;) ,1 / 1 <br /> Name: Phone No.: <br /> Address: City: Zip: <br /> Complainant: <br /> Owner/Resident: A /./ Phone No.: ie j <br /> Address: L <br /> z City: Zip: <br /> DETAILS OF COMPLAINT(Be specific as to time,duration,location, and nature of complaint): <br /> ? Cey C Y C7 r 7jc,, I r$y8^ zi <br /> t <br /> PA 7j / I / <br /> / /7 ="Y�:..r- is ,.'- rC'�r Lam. � -r <br /> Has this complaint been reported previously? If yes,whom and to whom specifically was complaint <br /> reported? What action resulted from complaint? <br /> Would you like to be contacted to know the kind of action that will be taken?Yes '"' No <br /> Have you or your neighbors spoken with the individual(s)in question in order to resolve the problem? <br /> • <br /> Signature of Complainant(s) 1). Date: <br /> I request my name not be disclosed (Initial). Your name will be held in confidence unless <br /> formal enforcement action requires your appearance as a witness. <br /> Complaint Received by: _ �; rij _ F . � Time: fir,, - / ' ` Date: <br /> l <br />
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