Lacey, WA · Thurston County
Appeal of an Administrative Determination
This form lets an appellant give written notice to the Lacey Hearings Examiner challenging an administrative decision made by a city official.
What this form is
Use this form to appeal an administrative decision to the Lacey Hearings Examiner. The appellant identifies the decision, the official who made it, the related matter, and the alleged errors, then requests that the decision be reversed. The form says to attach an additional sheet if more space is needed and includes fields for city filing and hearing records.
Who needs it
A person appealing an administrative decision made by a city official completes this form as the appellant.
How to submit it
The form identifies the Community Development Department for filing. It does not provide a mailing address or other submission method; check the city website for current contact details.
About notarization
This appeal is signed and dated without a notary; the form does not identify any notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the Appeal of an Administrative Determination form.
- 2
Complete The Appeal
Enter the appellant and decision details, describe the related matter, and list the alleged errors.
- 3
Gather Additional Information
Attach an additional sheet if more space is needed to explain the alleged errors.
- 4
File With The Department
File the form with the Community Development Department; check the city website for current contact details.
Frequently asked questions
- What does the Appeal of an Administrative Determination do?
- It gives an appellant a way to provide written notice of an appeal to the Lacey Hearings Examiner and describe alleged errors in an administrative decision.
- Do I need a notary for the Appeal of an Administrative Determination?
- No. The form is signed and dated without a notary, and it does not identify any notarized or sworn attachment.
- How do I submit the appeal?
- The form identifies the Community Development Department for filing but gives no address or submission method. Check the city website for current contact details.
Need something notarized?
This Appeal of an Administrative Determination doesn’t need a notary — but if you have another Lacey form that does, a commissioned online notary can help.