HomeMy WebLinkAboutCitys Appeal Packet - RubyCITY OF RENTON I DEVELOPMENT SERVICES DIVISION
0. REPORT FOR THE CODE COMPLIANCE APPEAL HEARING
EXHIBITS
PROJECT NAME: Order to Correct
DATE OF HEARING: TBD
STAFF CONTACT: Eric Petzold
425.430.7277
The following exhibits were entered into the record:
CODE CASE NUMBER: CODE23-000052
VIOLATOR: Christine Ruby
VIOLATION 2316 NE 10th PI
LOCATION: Renton, WA 98056
Exhibit 1:
Code Compliance Narrative
Exhibit 2:
Warning of Violation & Photos
Exhibit 3:
Second Warning of Violation & Photos
Exhibit 4:
Notice of Violation and Order to Correct
WWW.RENTONWA.GOV 11055 SOUTH GRADY WAY, FLOOR SIX I RENTON, WASHINGTON 98057 1 425,430.7200
0CITY OF RENTON I DEVELOPMENT SERVICES DIVISION
REPORT FOR THE CODE COMPLIANCE APPEAL HEARING
EXHIBITS
PROJECT NAME: Order to Correct
DATE OF HEARING: TBD
STAFF CONTACT: Eric Petzold
425.430.7277
CODE CASE NUMBER: CODE23-000052
VIOLATOR: Christine Ruby
VIOLATION 2316 NE loth PI
LOCATION: Renton, WA 98056
EXHIBIT
Code Compliance Narrative
WWW.RENTONWA.GOV 11055 SOUTH GRADY WAY, FLOOR SIX I RENTON, WASHINGTON 98057 1 425.430.7200
RENTON CODE COMPLIANCE CODECASE#25-000003
NARRATIVE
Address: 2316 NE 101h pl
Renton WA. 98056
Violator: Christine Ruby
DATE 03-24-25
• RMC Violation: RMC 4-5-130 Membrane Structures
January 6th, 2025: 1 received an inspection request for membrane structure. Inspection
noted membrane structure in the front yard. I sent out a Warning of Violation Letter.
January 28th 2025: A site reinspection on January 28th, 2025 noted that the membrane
structure is still present and there has been no response from the owner. I sent out a
Warning of Violation Second Notice.
February 61h, 2025: 1 sent an email with a copy of the violation out to the owner.
February 241h 20251 spoke with Christine Ruby about the violation. She wanted to appeal
the violation. I told her that I would have to fine her in order to appeal to the Hearing
Examiner. She agreed and I sent a Notice of Violation Order to Correct.
I certify under penalty of perjury under the laws of the state of Washington that the
foregoin u nd correct.
signed on -3 - al Jin Renton, Washington
JAFFetzold—
Code Compliance Inspector
CITY OF RENTON I DEVELOPMENT SERVICES DIVISION
REPORT FOR THE CODE COMPLIANCE APPEAL HEARING
0 EXHIBITS
PROJECT NAME: Order to Correct
DATE OF HEARING: TBD
STAFF CONTACT: Eric Petzold
425.430.7277
CODE CASE NUMBER: CODE23-000052
VIOLATOR: Christine Ruby
VIOLATION 2316 NE 10th PI
LOCATION: Renton, WA 98056
EXHIBIT
Warning of Violation & Photos
WWW.RENTONWA.GOV 11055 SOUTH GRADY WAY, FLOOR SIX I RENTON, WASH INGTON 98057 1 425.430.7200
Warning of Violation
Issued To:
Christine Ruby
2316 NE 10th PI
Renton, WA 98056-2926
Armondo Pavone Mayor
Community & Economic Development Gina Estep, Administrator
Date: January 07, 2025
Code Case No: CODE25-000003
Owner (Tax -Payer): Christine Ruby
Violation Address:
2316 NE 10th PI
Renton, WA 98056-2926
An inspection of the above premises revealed violation(s) of the City of Renton Municipal Code and Ordinances listed
below. Compliance or corrective action must be completed by 1 /22/2025. If voluntary compliance is not achieved, a
Criminal Citation MAY be issued. The violation(s) listed below are deemed a Class 1 Civil Infraction pursuant to Chapter
7.80 RCW, and any such person shall be assessed a monetary penalty of up to two hundred fifty dollars ($250.00) per
violation. Each day or portion of a day the violation(s) remain shall constitute a separate offense.
VIOLATION 1: Membrane Structures
Investigation Date
01 /07/2025
Violation Note: Membrane structures are not allowed in the front yard. They must be in the backyard and
under 200 Square feet.
Code Cited: RMC 4-5-130 IPMC section 308.3 & 308.8
Code Text: Membrane Structures: Prohibited Areas 4-5-130, IPMC Section 308.3:
The City of Renton Municipal Code has adopted the 2018 Edition of the International Property
Maintenance Code. This code sets standards for membrane structures in the city.
308.8 Membrane structures: Membrane structures are considered outdoor storage, and
subject to the location restrictions in section 308.3. Such structures shall not exceed two
hundred (200) square feet in area. Membrane structures shall be immediately removed or
repaired in the event of disrepair or in the event of damage caused by weather, fire, collision,
accident or other forms of damage. Tarps and makeshift covers are prohibited for this use.
308.3: Prohibited areas for outdoor storage: Outdoor storage is prohibited on residentially
zoned property in the following areas: front yards, side yards, slopes greater than 15%,
designated open spaces, restricted areas or critical areas including wetlands, streams and
associated buffer areas.
Corrective Action: Remove the structure or move to an approved area. Membrane structures may not exceed 200
square feet in area and are not allowed in the front yard.
Issued By: Eric Petzold
Code Compliance Inspector
425-430-7277
epetzold@rentonwa.gov
Page 1 of 1
Alftk
City of Renton
raDIN Community & Economic Development
NY1055 South Grady Way
Renton WA 98057-3232
Issued To:
Christine Ruby
2316 NE 10th PI
Renton, WA 98056-2926
City of Renton
;R]Community & Economic Development
1055 South Grady Way
OF Renton WA 98057-3232
Issued To:
Christine Ruby
2316 NE 10th PI
Renton, WA 98056-2926
as- — 003
9589 0710 527❑ 2158 9580 18
9589 0710 5270 2158 9580 18
Uommun..
D
C
C
V
2
♦
W.
CD
7J-
.1,
M. '
. i
• ;� � ,.,fir
a a A
►N
'7'+ MW
1/8/25, 9:26AM
SeeClickFix 311 CRM
This is a private request and can only be viewed by the reporter and users on your account.
Closed
NE loth St
0
Change Status
NE loth PI Nc , "'
#18138970 (https://seeclickfix.com/issues/18138970)
L97
NE loth st
Esri Community Maps Contributors, WSU Facilities Services GIS, King County, WA State Parks GIs, ® OpenStreetMap Powered by Esri (https.//www.esri.com/)
47.499168778208535,-122.18755496767739 Edit Location
Code Compliance - Tent/Canopy Structures
Created Date:
01/03/2025 4:57 PM
2374 Ne 10th St Renton, WA, 98056, USA
Details
2316 NE 10th PL - THEY BUILT A CAROORT: VERY DEEPLY CONCERNED ABOUT A CARPORT BUILT RIGHT NEXT TO MY
PROPERTY AND HOW IT IS ANCHORED IN PLACE
Secondary Questions
Your name
DIANE PLUMMER-CRANSTON
Your address
2312 NE 10TH PL
Your city, state, zip
RENTON, WA 98056
Your phone number
425-745-6986
Tent/Canopy structure (please check all that apply):
Is not located in backyard, Is closer than six (6) feet to a structure, Does not comply with outdoor storage code
Name of alleged violator (if known)
No Answer Given
Description of violation
CODE CONCERNS ON HOW CLOSE IT IS TO MY PROPERTY
V3 Q4
Request Information
Reporter:
Diane Plummer -Cranston & (https://conversations.seeclickfix.com/organizations/1252/constituents/1425423)
Registered User
https://crm.seeclickfix.com/#/organizations/1252/issues/18138970 1 /4
1/8/25 9 26 AM SeeChckFix 311 CRM
r Diane Plummer -Cranston
u dmperanston@gmail.com
Report Method
Portal
Category: Recategorize
Code Compliance - Tent/Canopy Structures
Assigned to
Assign
You
Due Date Change Due Date
01/14/2025
SLA Expires at:
01/14/2025
Priority Prioritize
Normal
CEO on 4; (https.Hseeclickfix.com/accounts/121.
Subscribers Subscribe
There are currently no subscribers.
Status Log
Opened: 01/03/2025 4:57 PM
Closed: 01/06/2025 2:58 PM
Work Orders New Work Order
No work orders match Please try another filter.
Comments
All Public Only Internal Only
Diane Plummer -Cranston 2 (httPs'//conversations.seeclickfix.com/organizations/1252/constituents/1425423) 1 Registered
User
Opened
2316 NE 10th PL - THEY BUILT A CAROORT: VERY DEEPLY CONCERNED ABOUT A CARPORT BUILT RIGHT NEXT TO
MY PROPERTY AND HOW IT IS ANCHORED IN PLACE
https.//crm.seeclickfix.com/#/organizations/1252/issues/18138970 2l4
1/8/25, 9:26AM
SeeClickFix 311 CRM
Renton, WA &(https://seeclickfix.com/users/1693486) 1 Verified Offic al
Assignment
Renton, WA assigned this issue to Code Compliance North
01/03/2025 4:57 PM
['i
Flag . 01/03/2025 4:57 PM
Diane Plummer -Cranston &(https://conversations.seeclickfix.com/organizations/1252/constituents/1425423) 1 Registered
User
Comment
Address wrong - its 2316 NE loth PL Renton WA 998056
(https-.Hseeclickfix.com/rails/active_storage/representations/redirect/eyJfcm FpbH MiOnsi bWVzc2FnZS16l kJ Ba H BCSEt
mcWdFP51slmV4cC16bnVsbCwicHVyljoiYmxvYl9pZCJ9fQ==--
b44b95c4a99526d2b2e1 e213c59e4a5a8cfa3073/eyJfcmFpbHMiOnsibWVzc2FnZS16lkJBaDdDVG9MWm05eWJXRjBT
UOIKYWSCbFp3WTZCa 1 ZVT2hCaGRYUnZYMjl5YVdWdWRGUTZDbk4wY21 sd 1 ZEbOxjbVZ6YVhwbFNTSU 1 PREF3ZURZ
d01 BWTdCbFE91iwiZXhwljpudWxsLCJwdXliOiJ2YXJpYXRpb24ifX0=-
-09f1 d8a44f20164c6fe72999dd865d9ba60da451/1MG_0669 jpeg)
Flag • 01/03/2025 5:01 PM
Diane Plummer -Cranston Cj' (https://conversations.seeclickfix.com/organizations/1252/constituents/1425423) I Registered
User
Comment
concerned about closeness to my fence and house and that it is not a secured structure.
Flag • 01/03/2025 5:02 PM
Eric Petzold En" (https://conversations.seeclickfix.com/organizations/1252/constituents/949329) I Verified Official Edit
Closed
The City has created a code case (CODE25-00003) for this issue. Notice has been sent to the property owner to
resolve the violation. If the violation remains further compliance action will be taken. For future correspondence
regarding this case, please contact the Code Compliance Inspector, Eric Petzold epetzold@rentonwa.gov or 425-
430-7277. Please reference the code case number.
Add a public comment.
Insert Prepared Content
d Add a Photo
Flag • 01/06/2025 2:58 PM
OO Public Internal
Post
https://crm.seeclickfix.com/#/organizations/1252/issues/18138970 314
CITY OF RENTON I DEVELOPMENT SERVICES DIVISION
REPORT FOR THE CODE COMPLIANCE APPEAL HEARING
0+.
G
EXHIBITS
PROJECT NAME: Order to Correct
DATE OF HEARING: TBD
STAFF CONTACT: Eric Petzold
425.430.7277
CODE CASE NUMBER: CODE23-000052
VIOLATOR: Christine Ruby
VIOLATION 2316 NE 10th PI
LOCATION: Renton, WA 98056
EXHIBIT
Second Warning of Violation & Photos
WWW.RENTONWA.GOV 11055 SOUTH GRADY WAY, FLOOR SIX I RENTON, WASHINGTON 98057 1 425.430.7200
Warning of Violation
Second Notice
Armondo Pavone Mayor
Community & Economic Development Gina Estep, Administrator
Issued To:
Date: January 29, 2025
Christine Ruby
Code Case No: CODE25-000003
2316 NE 10th PI
Owner (Tax -Payer): Christine Ruby
Renton, WA 98056-2926
Violation Address:
2316 NE 10th PI
Renton, WA 98056-2926
An inspection of the above premises revealed violation(s) of the City of Renton Municipal Code and Ordinances listed
below. Compliance or corrective action must be completed by 2/13/2025. If voluntary compliance is not achieved, a
Criminal Citation MAY be issued. The violation(s) listed below are deemed a Class 1 Civil Infraction pursuant to Chapter
7.80 RCW, and any such person shall be assessed a monetary penalty of up to two hundred fifty dollars ($250.00) per
violation. Each day or portion of a day the violation(s) remain shall constitute a separate offense.
VIOLATION 1: Membrane Structures
Investigation Date
01 /29/2025
Violation Note: A site reinspection on January 28th , 2025 noted that the membrane structure is still present
Code Cited: RMC 4-5-130 IPMC section 308.3 & 308.8
Code Text: Membrane Structures: Prohibited Areas 4-5-130, IPMC Section 308 3
The City of Renton Municipal Code has adopted the 2018 Edition of the International Property
Maintenance Code. This code sets standards for membrane structures in the city.
308.8 Membrane structures: Membrane structures are considered outdoor storage, and
subject to the location restrictions in section 308.3. Such structures shall not exceed two
hundred (200) square feet in area. Membrane structures shall be immediately removed or
repaired in the event of disrepair or in the event of damage caused by weather, fire, collision,
accident or other forms of damage. Tarps and makeshift covers are prohibited for this use.
308.3: Prohibited areas for outdoor storage: Outdoor storage is prohibited on residentially
zoned property in the following areas: front yards, side yards, slopes greater than 15%,
designated open spaces, restricted areas or critical areas including wetlands, streams and
associated buffer areas.
Corrective Action: Remove the structure or move to an approved area. Membrane structures may not exceed 200
square feet in area and are not allowed in the front yard.
Membrane structures are not allowed in the front yard. They must be in the backyard and
under 200 Square feet.
Membrane Structures: Prohibited Areas 4-5-130, IPMC Section 308.3:
The City of Renton Municipal Code has adopted the 2018 Edition of the International Property
Maintenance Code. This code sets standards for membrane structures in the city.
308.8 Membrane structures: Membrane structures are considered outdoor storage, and
subject to the location restrictions in section 308.3. Such structures shall not exceed two
hundred (200) square feet in area. Membrane structures shall be immediately removed or
repaired in the event of disrepair or in the event of damage caused by weather, fire, collision,
accident or other forms of damage. Tarps and makeshift covers are prohibited for this use.
Page 1 of 2
VIOLATION 1: Membrane Structures Investigation Date
01 /29/2025
308.3 Prohibited areas for outdoor storage: Outdoor storage is prohibited on residentially
zoned property in the following areas. front yards, side yards, slopes greater than 15%,
designated open spaces, restricted areas or critical areas including wetlands, streams and
associated buffer areas
Corrective Action: Remove the structure or move to an approved area. Membrane structures may not exceed 200
square feet in area and are not allowed in the front yard.
Issued By: Eric Petzold
Code Compliance Inspector
425-430-7277
epetzold@rentonwa.gov
Page 2of2
CD
ih
CD
LO
CD
co
C\j
CD
lie
CITY OF RENTON I DEVELOPMENT SERVICES DIVISION
REPORT FOR THE CODE COMPLIANCE APPEAL HEARING + G
EXHIBITS
PROJECT NAME: Order to Correct
DATE OF HEARING: TBD
STAFF CONTACT: Eric Petzold
425.430.7277
CODE CASE NUMBER: CODE23-000052
VIOLATOR: Christine Ruby
VIOLATION 2316 NE 10th PI
LOCATION: Renton, WA 98056
EXHIBIT
Notice of Violation and Order to Correct
WWW.RENTONWA.GOV 11055 SOUTH GRADY WAY, FLOOR SIX I RENTON, WASHINGTON 98057 1 425.430.7200
Notice of Violation
a n d Order to Correct Armondo Pavone Mayor
Community & Economic Development Gina Estep, Administrator
Issued To: Date: 2/24/2025
Code Case No: CODE25-000003
Christine Ruby Owner (Tax -Payer): Christine Ruby
2316 NE 10th PI Violation Address:
Renton, WA 98056-2926 2316 NE 10th PI
Renton, WA 98056-2926
An inspection of the above premises on 01/07/2025, 01/29/2025, and 02/24/2025 by a Code Compliance
Inspector revealed violation(s) of the City of Renton Municipal Code and Ordinances listed below. Compliance or
corrective action must be completed by 3/11/2025.
The violation(s) listed below are deemed a Class 1 Civil Infraction pursuant to Chapter 7.80 RCW, and any such
person shall be assessed a monetary penalty of up to two hundred fifty dollars ($250.00) per violation. Each day or
portion of a day the violation(s) remain shall constitute a separate offense.
If voluntary compliance is not achieved, a Criminal Citation MAY be issued [RMC1-10-3.E]. The penalty for a
criminal Citation, upon a finding of guilt shall have a mandatory minimum sentence of five (5) days in jail without
the option of electronic home detention, and the minimum penalty for the first violation shall be five hundred
dollars ($500), the second criminal violation shall have a mandatory minimum sentence of fifteen (15) days in jail
without the option of electronic home detention, and the minimum penalty for the second violation shall be six
hundred twenty five dollars ($625), the third criminal violation for any individual shall have a mandatory minimum
sentence of thirty (30) days in jail without the option of electronic home detention, and the minimum penalty for
the third violation shall be seven hundred fifty dollars ($750) [RMC1 -1 0-7.A.2].
VIOLATION 1: Membrane Structures
Reported Date Issued Date Latest Investigation Date
1 /7/25 1 /7/25 2/24/25
Violation Note: Please fill out the bottom of the paper and send back to the city for an appeal.
Code Cited: RMC 4-5-130 IPMC section 308.3 & 308.8
Code Text: Membrane Structures: Prohibited Areas 4-5-130, IPMC Section 308.3:
The City of Renton Municipal Code has adopted the 2018 Edition of the International
Property Maintenance Code. This code sets standards for membrane structures in the city.
308.8 Membrane structures: Membrane structures are considered outdoor storage, and
subject to the location restrictions in section 308.3. Such structures shall not exceed two
hundred (200) square feet in area. Membrane structures shall be immediately removed or
repaired in the event of disrepair or in the event of damage caused by weather, fire, collision,
accident or other forms of damage. Tarps and makeshift covers are prohibited for this use.
308.3: Prohibited areas for outdoor storage: Outdoor storage is prohibited on residentially
zoned property in the following areas: front yards, side yards, slopes greater than 15%,
designated open spaces, restricted areas or critical areas including wetlands, streams and
associated buffer areas.
Corrective Action: Remove the structure or move to an approved area. Membrane structures may not exceed
200 square feet in area and are not allowed in the front yard.
Page 1 of 3
I certify under penalty of perjury under the laws of the State of Washington that I have issued this Notice of Violation
on this date and at the location stated above I certify that I believe by a preponderance of the evidence that the
violator committed the above violation(s).
Signed.���� Date: 02-24-25
Issued By.Eric Petzold
Code Compliance Inspector
425-430-7277
epetzold@rentonwa.gov
Page 2 of 3
Code Case No: CODE25-000003 Date: 2/24/2025
Violation Address:
2316 NE 10th PI
NOTICE OF RENTON MUNICIPAL CODE VIOLATION
The City has elected to establish a non -judicial hearing and determination system to enforce Renton Municipal Codes (RMC)
civil code violations. Therefore a code violation penalty, consistent with RMC 1-3-2.P is imposed, not including any costs,
fees or assessments. You may respond in the following manner:
❑ I deny creating, permitting to exist, maintaining or failing to eliminate the violation(s) and I am requesting a hearing to
contest this Notice of Violation. Appeal requests must be received by the Renton City Clerk's office within 15 days of the
date of this Notice of Violation. Please send me a hearing date. I promise to appear on that date. The administrator must
prove by a preponderance of the evidence that I committed the violation. I understand that under RMC 1-3-2.G that the
administrator shall decide whether the opportunity to be heard will be only in writing or in person, or both. The city is not
required to call witnesses to testify at the hearing. Pursuant to RMC 1-3-2.K, failure to attend the scheduled hearing
makes the Notice of Violation final, and I may be subject to additional costs if I fail to withdraw or resolve my appeal prior
to the hearing date. I also understand that the city has not waived any rights or remedies under the law.
Appeals should be mailed to: City of Renton
Attention: City Clerk
1055 S Grady Way
Renton, WA 98057
❑ I admit that I have created, permitted to exist, maintained or failed to eliminate the violation(s) and do not need or want any
kind of hearing. As a result, I have enclosed a check or money order (do not send cash) in the amount of $ . I
understand I am required to bring the property into compliance with City of Renton Municipal Code. I also understand that
if compliance is not achieved I may be issued additional Notice of Violation with increasing penalties, and or criminally
prosecuted. NSF checks will be treated as failure to respond.
Payment should be made to: City of Renton
Attention: 1st Floor Finance
1055 S Grady Way
Renton, WA 98057
Complete information below: (PLEASE PRINT;
Name:
Street or P.O. Box:
City:
Telephone: Home: _
Email:
Signature of Violator
State: Zip:
Work:
Date:
Page 3 of 3
City of Renton
• Community & Economic Developmen
1055 South Grady Way
Renton WA 98057-3232
Issued To:
Christine Ruby
2316 NE 10th PI
Renton, WA 98056-2926
0589
5854
07
1
9589
0710
5270
9589
0710
5270
0589
5854
07
Adabiii, 1
City of Renton
Community & Economic Development
DRY055 South Grady Way
Nkor Renton WA 98057-3232
JJucY 1 V.
Date.
Christine Ruby
Code
2316 NE 10th PI
Ownei
Renton, WA 98056-2926
Violatl
2316 IN
An inspection of the above
Rentor
premises on 01/07/2025, 01/29/202
and
as - 003
CITY OF RENTON I DEVELOPMENT SERVICES DIVISION
14,
0+.
REPORT FOR THE CODE COMPLIANCE APPEAL HEARING
EXHIBITS
PROJECT NAME: Order to Correct
DATE OF HEARING: TBD
STAFF CONTACT: Eric Petzold
425.430.7277
CODE CASE NUMBER: CODE23-000052
VIOLATOR: Christine Ruby
VIOLATION 2316 NE 10th PI
LOCATION: Renton, WA 98056
EXHIBIT
5
WWW.RENTONWA.GOV 11055 SOUTH GRADY WAY, FLOOR SIX I RENTON, WASHINGTON 98057 1 425.430.7200
Code Case No: CODE25 000003 CITY Q&1RF z5
Violation Address:
2316 NE 10th PI MAR 112025
NOTICE OF RENTON MUNICIPAL CODE VIOLATION CITY RECEIVED
The City has elected to establish a non -judicial hearing and determination system to enforce Renton Mum p�'Cbtle�s awe
civil code violations Therefore a code violation penalty consistent with RMC 1--3-2 P is imposed, not including any costs
fees or assessments You may respond in the following manner
I deny creating permitting to exist, maintaining or fading to eliminate the violation(s) and I am requesting a hearing to
contest this Notice of Violation Appeal requests must be received by the Renton City Clerks office within 15 days of the
date of this Notice of Violation Please send me a hearing date I promise to appear on that date The administrator must
prove by a preponderance of the evidence that I committed the violation I understand that under RMC 1 3-2 G that the
administrator shall decide whether the opportunity to be heard will be only in writing or in person or both The city is not
required to call witnesses to testify at the hearing Pursuant to RMC 1-3-2 K, failure to attend the scheduled hearing
makes the Notice of Violation final, and I may be subject to additional costs if I fad to withdraw or resolve my appeal prior
to the hearing date I also understand that the city has not waived any rights or remedies under the law
Appeals should be mailed to City of Renton
Attention: City Clerk
1055 S Grady Way
Renton, WA 98057
I admit that I have created permitted to exist maintained or faded to eliminate the violation(s) and do not need or want any
kind of hearing As a result I have enclosed a check or money order (do not send cash) in the amount of $ 1
understand I am required to bring the property into compliance with City of Renton Municipal Code I also understand that
if compliance is not achieved I may be issued additional Notice of Violation with increasing penalties and or criminally
prosecuted NSF checks will be treated as failure to respond
Payment should be made to City of Renton
Attention: 1st Floor Finance
1055 S Grady Way
Renton, WA 98057
Complete in7r�
ation below (PLEASE PRINT
Name P 15 7 i M- 40 I7A V
Street or P O Box �3 a )
City Y\ State_ Zip b�
Telephone Home Wo
Email 0ru c tn eac,t, nel
36 �
Signature of Violator A44,4, Date
Page 3 of 3
LO
ITI
-..I
M
('-I
Ki
th
41
CP
00
C')
rn
J (n
J
`�
2�
73
N
0
rQ
Ln