If you wish to report a violation concerning a restaurant, tavern or grocery store, please complete the form below. An asterisk next to an item indicates it is required for processing.

Violation Report
Date Violation Occurred Date  
<February 2010>
SunMonTueWedThuFriSat
31123456
78910111213
14151617181920
21222324252627
28123456
78910111213
Time Violation Occurred (HH:MM) 24-hour  
Premises Category Category    
Violation Type Type  
* Premises Name Name  
Address Address  
City City  
State Washington
Phone Phone  
Please describe the alleged violation

 

To process a complaint investigation, you must provide your contact information

Contact information
Do not release my name
Name
Title
Address
Telephone
FAX
E-mail

Note

Enter the code below (Required) and Submit
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