Owner/Applicant
Contact Person
Mailing Address
Phone # FAX #
q Check here if you wish to be notified of the committee’s decision by email
Email Address ___________________________________________________________
Violation
Appeal Description:
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Owner’s Signature Date
Please return completed application to:
Acer NW
5017 196th St SW #103
Lynnwood, WA 98036
Lynnwood, WA 98036
Submission deadline must be within 10 days of initial violation. The committee will respond within a reasonable amount of time.
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