CASH OR CHECK ONLY PLEAS
CITY OF LACEY
Community & Economic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
OWNER:
Address: City: State: Zip:
Phone: Email:
Address: City: State: Zip:
Contractor's License No. Exp: City Bus. Reg.
NOTE: THIS APPLICATION MUST BE ACCOMPANIED BY TWO SETS OF CONSTRUCTION PLANS, TWO SETS OF STRUCTURAL
CALCS, TWO FULLY DIMENSIONED SITE PLANS, AND TWO DETAILED LANDSCAPING PLANS, IF APPLICABLE.
MISCELLANEOUS BUILDING PERMIT APPLICATION
CONTACT PERSON: Address:
Project Address:
A 65% PLAN CHECK FEE MAY BE REQUIRED AT TIME OF APPLICATION.
Type of Permit (check one): ( ) RESIDENTIAL ( ) COMMERCIAL
Parcel Number:Suite:
Project Value:
Applicant's Signature
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of
General Contractor:
Print Applicant's Name Date
the above described property will be in accordance with the laws, rules and regulations of the State of Washington.
Construction Type: Occupancy Type:
Proposed Scope of Work:
Phone Number:
Phone Number: Cell Phone: Email:
TENANT:
FORM: MISC-2 / 10-07
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signature
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