Fillable CITY OF LACEY Community and Economic Development Department (City of Lacey)

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CITY OF LACEY Community and Economic Development Department (City of Lacey)

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FORM: BPC-2 / 09-06
CASH OR CHECK ONLY PLEASE
CITY OF LACEY
Community and 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.
CLOTHES WASHERS
SINKS
BATH TUBS
TENANT:
SCOPE OF WORK:
Phone Number:
Phone Number:
DRINKING FOUNTAINS
GREASE TRAPS
BACKFLOW OVER 2"
BACKFLOW UP TO 2"
GAS OUTLETS
WATER PIPING
DWV ALTER/REPAIR
LAWN SPRINKLER
AV BREAKERS
GREASE INTERCEPTORS
Parcel Number:
DISHWASHERS
ROOF DRAINS
FLOOR DRAINS
URINALS
SUMPS
SHOWERS
LAVATORIES
WATER CLOSETS
LAUNDRY TUBS
WATER HEATERS
MISC.PLUMBING FIXTURES
SIDE SEWERS
FLOOR SINKS
PLUMBING PERMIT APPLICATION
CONTACT PERSON:
Business:
Type of Permit (check one): ( ) RESIDENTIAL ( ) COMMERCIAL
PLEASE LIST QUANTITY OF FIXTURES BELOW:
Suite:
Cell Phone: Email:
Applicant's Signature
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of
Plumbing 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.
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CITY OF LACEY Community and Economic Development Department (City of Lacey)

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Completed 3 August 2020

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