PLUMBING AND GAS PERMIT
JURISDICTION OF LACY LAKEVIEW
WHEN THE PERMIT IS APPROVED AND PRICED, PLEASE CALL THE LACY LAKEVIEW BUILDING OFFICIAL AT 254-799-2458 TO MAKE A PAYMENT.
JOB ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
OWNER
*
First Name
Last Name
Phone Number
*
Owner Phone Number
Format: (000) 000-0000.
CONTRACTOR
*
First Name
Last Name
Phone Number
*
Contractor Phone Number
Format: (000) 000-0000.
CONTRACTOR EMAIL
*
example@example.com
CLASS OF WORK
*
Please Select
NEW
ADDITION
ALTERATION
REPAIR
DESCRIPTION OF WORK:
*
TYPE OF FIXTURE OR ITEM
WATER CLOSET (TOILET)
BATH TUB
LAVATORY (WASH BASIN)
SHOWER
KITCHEN SINK & DISP.
DISHWASHER
LAUNDRY TRAY
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR SINK OR DRAIN
SLOP SINK
GAS SYSTEM NO. OF OUTLETS
WATER PIPING AND TREATING EQUIPMENT
WASTE INTERCEPTOR
VACCUUM BREAKERS
LAWN SPRINKLER SYSTEM
SEWER
CESSPOOL
SEPTIC TANK AND PIT
File Upload
Browse Files
Drag and drop files here
Choose a file
PLANS (IF REQUIRED FOR PROJECT)
Cancel
of
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
PAYMENT STATUS
Please Select
PAID
UNPAID
Preview PDF
Submit
Should be Empty: