FORM: GRAD-1
CITY OF LACEY
Community & Economic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
CASH OR CHECK ONLY PLEASE
GRADING PERMIT APPLICATION
THIS APPLICATION MUST BE ACCOMPANIED BY FOUR SETS OF GRADING PLANS SHOWING THE FOLLOWING:
( ) Property lines and boundaries
( ) Existing contours
( ) Final grade contours
( ) Location of drainage and stream courses
( ) Location of existing structures
( ) Location of proposed structures
( ) Erosion control plan for construction phase
( ) Design of any soil retention structures (retaining walls)
( ) Geotechnical soils analysis report
( ) Infiltration analysis report
Type of Permit (check one) ( ) Residential Subdivision ( ) Commercial Subdivision ( ) Commercial Bldg. Site
( ) Residential Bldg. Site ( ) Other ___________________________________________
Amount of Cut (cubic yards) ____________________________________ Amount of Fill (cubic yards) _______________________
Project Location/Address _______________________________________ Parcel Number __________________________________
Owner _______________________________________________________ Phone Number ______________________________
Address ________________________________________ City ____________________ State _________ Zip _______________
Contact Person ________________________________________________ Phone Number _____________________________
Cell Phone _________________________ Fax Number _________________________ E-mail _____________________________
Address ________________________________________ City ____________________ State _________ Zip _______________
Contractor ________________________________________________ Phone _________________ Fax ___________________
Address ____________________________ City _______________ State ______ Zip _________ E-mail ____________________
Contractor’s License Number ____________________________ Expiration _________ City Bus. Reg. _______________________
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-
described property will be in accordance with the laws, rules and regulations of the State of Washington.
________________________________________________________ ________________________________________
Applicant’s Signature Date
________________________________________________________
Print Applicant’s Name
click to sign
signature
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