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Public Records Request Form
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Name of Person Requesting Records
Description of Records Requested
Please be specific in describing the record(s) being requested and any additional information that will aid in the location of the record(s) such as title and/or date of record. For maps or as builts, use a general narrative such as “Requesting water/sewer as builts adjacent to and within 500 feet of the project parcel.”
Tax Parcel ID Number (10 Digits) (If request is not property-specific, type "n/a")
Parcel Owner Name
Project Name (if applicable)
Project Scope (i.e. short plat, real estate inquiry, etc.)
Preferred Media Format
Electronic - Supplied in native file format (i.e. tif, dxf, shp, pdf, txt, doc, dbf)
Preferred Hardcopy Type
8 ½ x 11
11 x 17
Preferred Electronic Medium
Digital Media Storage or Device *Subject to additional charge
Preferred Delivery Notification Method
I wish to have copies of the records indicated above. I understand that there will be a charge for duplication of the requested records, in hard copy or electronic format, in an amount established by District resolution. The requestor may be required to provide a deposit in the amount of ten percent of the estimated cost of providing copies of the records. If the District provides copies of records on a partial or installment basis, the requestor shall pay the copy charge for each installment as it is provided to the requestor.
I wish to make an appointment to review the records indicated above before copies are made.
RCW 42.56.070(8) prohibits the disclosure of lists of individuals for commercial purposes. Please affirm one of the following statements by selecting the appropriate option:
My request includes a list(s) of individuals, and certify I will not use any requested lists for commercial purposes.
My request does not include a list of individuals.
Comments/List Information Provided
Request Was Satisfied
Denied for the Following Reason
GIS Project #
The District will charge all costs of public records when the combined, applicable fees are in excess of ten dollars ($10.00).
U.S. Mail or UPS (Res.# 4874)
$0.15 (8-1/2-inch x 11-inch, 8-1/2-inch x 14-inch, and 11-inch x 17-inch) (Res. # 4874)
$0.10 cents/page scanned (Res. #4874)
$0.05 cents/4 files or attachments and provided by electronic delivery (Res. #4874)
$0.10 cents/gigabyte of electronic records transmission (Res. #4874)
Actual costs of storage media, container, envelope, postage/delivery charge (Res. #4874)
$5 (24” X 36” Drawing Sheet) (Res. # 4874)
$10 Aerial Mapped Sheet ($5 for each overlay) (Res. # 4874)
$130/hour for GIS Information printouts (Res. #4794) (The District shall charge the time required to compile specialized information technology for GIS information and for printouts.)
Alternative Fees: Check if applicable
$2.00 flat fee
Alternative fee arrangement
Customized fees for IT access/expertise
Number of Copies
Number of Copies
Number of Copies
Number of Copies
District Policies and Intended Use
It is the District’s policy to respond to a records request within 5 business days of receiving a public records request by either: (1) providing the record for inspection or copying; (2) providing an internet address and link on the District’s website to the specific records requested; (3) acknowledging the District has received the request and providing a reasonable estimate of the time the District will require to respond to the request; or (4) denying the request. Additional time required to respond to a request may be based on the need to clarify the intent of the request, to locate and assemble the information requested, to notify third persons or agencies affected by the request or to determine whether any of the information requested is exempt and that a denial should be made to all or part of a request. In acknowledging receipt of a request that is unclear, the District may ask the requester to clarify what information the requester is seeking. If the requester fails to clarify the request, the District need not respond to it. See RCW 42.56.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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