HomeMy WebLinkAbout2 - Notice of Violation AppealRECEIVED
AUG 14 2026
Jefferson County 1EFFERSON COUNTY
COMMISSIONERS
Notice of Violation
Appeal to the Hearing Examiner
APPELLANT INFORMATION (Person or group making the appeal)
1. Appellant:
Name: {MI cl-t C
Address: Z 70 W . 1'l ,,J, " C•''+ (n C C. t; 4
Email Address:
y _
COM Case and Parcel Number: L c (y1 - 2c u L e 6 (,
In what format do you wish to receive documents from the Office of Hearing
Examiner?
Check one: U.S. Mail F-1 Email Attachment Both
2. Authorized Representative:
Name of representative if different from the appellant indicated above. Groups and
organizations must designate one person as their representative/contact person.
Name:
Address:
Phone:
Email Address:
In what format do you wish to receive documents from the Office of Hearing
Examiner?
Check one: U.S. Mail -1 Email Attachment =Both
There are additional
pages to this document,
releasable upon request
APPEAL INFORMATION
Answer each question as completely and specifically as you can. Attach separate sheets if
needed.
What are your objections to the decision? (List and describe what you believe to be the
errors, omissions, or other problems with this decision.)
2. What relief do you want? (Specify what you want the Examiner to do: reverse the
decision, modify conditions, etc.)
Signature Date_q lj
Deliver or mail appeal form and appeal fee to:
JEFFERSON COUNTY PUBLIC HEALTH
Attn: Becca Maurer, Code Compliance Specialist
615 Sheridan Street I Port Townsend, WA 98368
bmaurer@co.jefferson.wa.us
For Questions call or email 360-379-4467 1 email: bmaurer@co.jefferson.wa.us
Appeals will not be accepted through email or without payment of fee*