Survey Request

Name: Laco Associates
Address: 155 North Main Street, Fort Bragg, CA, 95437

Survey Information
Select the type of survey desired from these services provided:*
Elevation Certificate service base fee starts at $1,500.*
Please further describe your survey request:*
Contact Information
Property Owner or Authorized Representative*
First Name Last Name
Phone Number*
Email Address*
Mailing Address*
Street Address City State ZIP Code
Property Information
Property Owner's Name*
Building Owner Name or other Name to be placed on the completed Certificate.
Property Address*
Street Address City State ZIP Code
Assessor's Parcel Number (optional)
Zoning/Use of Property*
- Residential
- Commercial
- Industrial
Certificate will be based on:*
- Construction Drawings
- Building Under Construction
- Finished Construction
Billing Information
Billing Information Is The Same As Contact Information*
- Yes
- No
Client Name*
First Last
Client Phone Number*
Client Email Address*
Billing Address*
Street Address City State ZIP Code
Consent*
I agree to the terms below.
Upon receipt of this Survey Request Form, service fee quote will be provided. If accepted, information submitted will be used to prepare a LACO Service Agreement for your review and signature. Authorization to proceed requires Client signature and initials on Service Agreement and full payment (100%) of fee as retainer. Completed Elevation Certificate is typically delivered 7 to 10 business days from the date of authorization. Retainer will be applied to final invoice.
Consent*
I agree to the terms below.
*Upon receipt of this Survey Request Form, a service fee quote will be provided. If accepted, information submitted will be used to prepare a LACO Service Agreement for your review and signature. Authorization to proceed requires Client signature and initials on Service Agreement and retainer deposit.
Comments
This field is for validation purposes and should be left unchanged.

Eureka: 21 West 4th Street, Eureka, CA 95501: +1 707-443-5054
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