Applicant's Signature
FORM:
CAA 02/2016
CASH OR CHECK ONLY PLEASE
CITY OF LACEY
Community & E
conomic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
NOTE: THIS APPLICATION MUST BE ACCOMPANIED BY TWO SETS OF CONSTRUCTION PLANS, TWO SETS OF SPECIFICATIONS,
NOTE: In all cases, a valuation construction amount shall be entered by applicant. This figure will be
Project Value:
reviewed and is subject to possible revision by permit staff to comply with current fee schedules.
T.I. sq ft: Building Overall sq ft: Construction Type: Occupancy Type:
Fire Sprinklers:
( ) Yes ( ) No Fire Alarm: ( ) Yes ( ) No
Expansion of Building Footprint: ( ) Yes ( ) No If yes, must show all easements/utilities on site plan.
Is there a backflow prevention device protecting the building/suite's domestic water service? ( ) Yes ( ) No ( ) Unknown
Are any traffic mitigation fees associated with the project? ( ) Yes ( ) No ( ) Unknown
Are any utility connection fees associated with the project? ( ) Yes ( ) No ( ) Unknown
If you answered Unknown to any of these, contact Lacey Public Works at (360) 491-5600 for more information.
BUILDING OWNER:
Address: City: State: Zip:
City: State: Zip:
Phone Number:
Cell Phone: Email:
G
eneral Contractor:
Phone Number: Cell Phone: Email:
A
ddress: City: State: Zip:
Contractor's License No. Exp: City Bus. Reg.
Address:
Suite:
Has project gone through Site Plan Review: ( ) Yes ( ) No
COMMERCIAL REMODEL PERMIT APPLICATION
CONTACT PERSON:
Project Address:
TWO SETS OF STRUCTURAL CALCS, ONE ENERGY CODE APPLICATION (IF APPLICABLE), AND TWO SETS OF FULLY
DIMENSIONED SITE PLANS. A 65% PLAN CHECK FEE IS REQUIRED AT SUBMITTAL FOR COMMERCIAL PROJECTS THAT EXCEED $25,000.
TENANT NAME:
Type of Permit (check one): ( ) Commercial Remodel ( ) Commercial Addition ( ) Tenant Improvement
Phone Number:
Any Changes to the Following: Signage: ( ) Yes ( ) No Parking: ( ) Yes ( ) No Landscaping: ( ) Yes ( ) No
Parcel Number:
Describe Scope of Work:
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of
Date
the above described property will be in accordance with the laws, rules and regulations of the State of Washington.