Fillable COMPLAINT FORM: To report a complaint about a (Kittitas County WA)

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COMPLAINT FORM: To report a complaint about a (Kittitas County WA)

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COMMUNITY PLANNING BUILDING INSPECTION PLAN REVIEW ADMINISTRATION PERMIT SERVICES CODE ENFORCEMENT
KITTITAS COUNTY COMMUNITY DEVELOPMENT SERVICES
411 N. Ruby St., Suite 2, Ellensburg, WA 98926
CDS@CO.KITTITAS.WA.US
Office (509) 962-7506
“Building Partnerships – Building Communities”
COMPLAINT FORM: To report a complaint about a building, land use or environmental code violation in
Kittitas County. Please try to be specific in the information provided for this investigation.
Location of property in violation: _____________________________________________________
Parcel or Map Number: ___________________________________________________________
Property owner’s name: ____________________________________________________________
Occupant or responsible Party if not the property owner: __________________________________
TYPE OF VIOLATION:
[ ] Construction without a permit or the installation of any unapproved plumbing or mechanical device.
[ ] Land use or development without a permit.
[ ] Operation of an illegal business or other zoning violation.
[ ] Septic installation without a permit or system failure.
[ ] Storage of junk cars/appliances/scrap materials/solid waste.
[ ] Substandard housing or other property maintenance issues.
[ ] Work or development in an area of flood hazard, wet lands or other critical areas.
[ ] Other.
Complaint_Details:___________________________________________________________________
__________________________________________________________________________________
Is this an ongoing violation?(Yes) (No) When did it start? _________________________________
Have any other agencies been contacted regarding this complaint? (Yes) (No)
Agency: ____________________________________
Complaints will not be accepted without your name and contact information.
Name: ___________________________________________________________________________
Address: __________________________________________________________________________
Phone: _______________________________ Email: _____________________________________
***If you would like your name to remain confidential you may initial here ______, but you must
provide the information requested above.
Received by: ____________________________________ Date: ________________________
SG #: ________________________
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COMPLAINT FORM: To report a complaint about a (Kittitas County WA)

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Completed 30 July 2020

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