FORM: ROOF-1
CITY OF LACEY
Co
mmunity and Economic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
CASH OR CHECK ONLY PLEASE
REROOF PERMIT APPLICATION
Type of Permit (check one): ( ) Residential ( ) Commercial
P
roject Address __________________________________________________ Parcel Number ______________________________
Owner ______________________________________________________________ Phone Number _______________________
A
ddress ______________________________________ City _______________ State _________ Zip Code __________________
Contractor _________________________________________________ Phone _________________ Fax ________________
Address ____________________________ City _______________ State ______ Zip _________ E-mail ___________________
Contractor’s License Number ____________________________ Expiration _________ City Bus. Reg. ______________________
T
ype of Roofing __________________ Number of Layers _______________ Number of Squares ________________
C
lass of roofing ( ) A ( ) B ( ) C Valuation of Reroof: ________________________________
Work scheduled to begin: __________________________ Work scheduled to end: ___________________________
The following information is required for Non-Residential roofs:
(
) All Non-Residential* projects will require a site visit prior to issuance to check for obvious signs of structural fatigue, condition
of existing roofing and number of existing layers.
(
) Two copies of the installation specifications and U.L. listed roof assembly.
( ) Building Square Footage:
(
) Occupancy of Building: _________ Office
_________ Retail
_________ Church
_________ Restaurant
_________ School
I
hereby certify 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. The applicant will be
responsible for providing a method of safely accessing roof for inspection. A final inspection and approval shall be obtained when
the re-roofing is complete.
________________________________________________________ ________________________________________
Applicant’s Signature Date
_
_______________________________________________________
Print Applicant’s Name
click to sign
signature
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