Code Compliance Concern Form

Code Compliance Concern Form
Your Full Name

First NameLast Name
Your E-mail
example@example.com
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location of Problem / Concern*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the Problem or Concern you are reporting?*
File Upload

Not Required, but it may be requested at a later date
Cancelof
PLEASE NOTE: THIS FORM IS A PUBLIC RECORD AND MAY BE DISCLOSED BY THE CITY IF REQUESTED.
Confidentiality Preference: If you believe that disclosure of your identity would threaten your safety or property, you may request that your identity not be disclosed under RCW 42.56.240(2). Be advised, your request is not a guarantee that your identity will be protected from disclosure. Disclosure of information revealing your identity will depend on a number of factors including
Chapter 42.56 RCW (the Public Records Act), other applicable laws, and whether the complainant is criminally prosecuted. With that understanding, PLEASE INDICATE YOUR DESIRE FOR DISCLOSURE OR NON-DISCLOSURE OF YOUR
IDENTITY BY CHECKING THE APPROPRIATE BOX, AND SIGN AND DATE BELOW:
Yes, it is ok to disclose my informationNo, do not disclose my information
Should be Empty: