FORM: FSPK-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
FIRE SPRINKLER PERMIT APPLICATION
P
LEASE INCLUDE (4) SETS OF COMPLETE AND SCALED PLANS FOR EACH FIRE SPRINKLER PERMIT APPLICATION. INCLUDE
ELECTRICAL PLANS WHERE APPLICABLE. ALSO, INCLUDE SPECIFICATION SHEETS, WIRING DIAGRAMS (POINT TO POINT
WIRING), AND ALL OTHER INFORMATION ON EQUIPMENT PROPOSED TO BE INSTALLED PRIOR TO INSTALLATION.
Type of Permit (check one): ( ) New Fire Sprinkler ( ) Fire Sprinkler Add/Alt ( ) Underground Fire Sprinkler
P
roject Address _____________________________________________ Parcel Number ___________________________________
P
roject Value _____________________ Number of Heads ___________________ Building Area (Sq. Ft.) ____________________
Owner ________________________________________________________ Phone Number ______________________________
A
ddress ________________________________________ City ____________________ State _________ Zip _______________
Contact Person ________________________________________________ Phone Number _____________________________
C
ell Phone _________________________ Fax Number _________________________ E-mail _____________________________
A
ddress ________________________________________ City ____________________ State _________ Zip _______________
Contractor ________________________________________________ Phone _________________ Fax ___________________
Address ____________________________ City _______________ State ______ Zip _________ E-mail ____________________
Contractor’s License Number ____________________________ Expiration _________ City Bus. Reg. _______________________
I
hereby certify that 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.
_
_______________________________________________________ ________________________________________
Applicant’s Signature Date
________________________________________________________
Print Applicant’s Name
click to sign
signature
click to edit
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