Fillable APPLICATION FOR P LUMBING PERMIT

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APPLICATION FOR P LUMBING PERMIT

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Orange County Division of Building Safety
201 South Rosalind Avenue
Reply To: Post Office Box 2687 • Orlando, Florida 32802-2687
Phone: 407-836-5550 • Fax 407-836-5492 • Inspections ONLY: 407-836-2825
www.ocfl.net/building
Date
Building Permit Number
______/______/______
___________________
Permi t Number
APPLICATION FOR P LUMBING PERMIT
WARNING TO OWNER: “YOUR FAILURE TO RECORD A NOTICE OF CO MMENCEMENT M AY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT M UST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF Y OU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.”
PLEASE PRINT:
The undersigned hereby applies for a permit to make plumbing installations as indicated below on property.
Project Address: __________________________________________________________________
Suite/Unit #: ______________ Bldg #: ___________________ City: __________________ Zip Code: _____________
Subdivision Name: __________________________________________________________
Parcel ID Number: Section _ _ Township Range Subdivision ______ Block _____ Lot
(15 Digit Parcel Number)
_________ __ ____
Owner Name: ________________________________________ Phone No.: (______)______-__________
Owner Address: ______________________________________ City: ______________ State: ____ Zip Code: ________
Class of Building: Existing __ New __ Type of Structure: Residential (028) __ Commercial (029) __ Mobile Home (006) __
Scope of Work: New (001) __ Alteration (003) __ Addition (004) __ Repair (002) __
Date First Inspection Desired: ________/_______/____________ or will call __
_________________________
Permit valuation greater than $2500 requires a notarized Page 2, and Notice of Commencement prior to the first inspection.
FIXTURES QUANTITY
2
nd
Meter ____
Bathtub(s) ____
Dishwasher(s)
____
Disposal(s) ____
Drinking Fountain(s)
____
Floor Drain(s)
____
Irrigation
(# of heads) ____
Laundry Tub(s) ____
FIXTURES QUANTITY
Lavatories ____
Pool Piping ____
Re-pipe only
(No additional work)
____
Service Sink(s) ____
Shower(s)
____
Sink(s)
____
Spa ____
* Solar
FIXTURES QUANTITY
____
Trailer Connection(s) ____
Urinal(s) _
___
Washing Machines
____
Water Closets (Toilets) ____
Water Heater(s)
____
Water
Softener
____
Misc: _________________ ____
* Electrical wiring over 50 volts RMS
requires separate electrical permit
Quantity
Grease Trap/Interceptor ____ Size ______ Gal._______ New Replace Remove
Sewer ____ New Water Connection: Yes No
New Waste water Connection: Yes No
Total Job Valuation: $______________
I hereby make Application for Permit as outlined above, and if same is granted I agree to conform to all Division of Building Safety Regulations and
County Ordinances regulating same and in accordance with plans submitted. The issuance of this permit does not grant permission to violate any
applicable Orange County and/or State of Florida codes and/or ordinances. I hereby certify that the above is true and correct to the best of my
knowledge.
PLEASE PRINT: (Check one) Owner: Contractor:
Name of License Holder/Agent: _______________________________________________
Contractor License Number (if applicable):_______________________________________
Contact Phone Number: (_____)_____-_________ E-Mail Address:___________________________________________
Authorized Signature: _______________________________________________________
NOTE: The Building Permit Number is required if the Mechanical Installation is associated with any construction or alteration
where a Building Permit has been issued.
Para más información en español, por favor llame al Departamento de Building Safety al número 407-836-5550.
23-14 (Rev 02/13) Page 1 of 2
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To be completed as required by State Statute Section 713 and other applicable sections.
Permit Application Information - Page Two
Owner’s Name ______________________________________________________________________________________________
Owner’sAddress_____________________________________________________________________________________________
Fee Simple Titleholder’s Name (If other than owner’s) ________________________________________________________________
Fee Simple Titleholder’s Address (If other than owner’s) ______________________________________________________________
City ____________________________________ State __________________________________ Zip Code____________________
Contractor’s Name ___________________________________________________________________________________________
Contractor’s Address__________________________________________________________________________________________
City ____________________________________ State __________________________________ Zip Code____________________
Job Name __________________________________________________________________________________________________
Job Address ___________________________________________________________________ SUITE/UNIT __________________
City ____________________________________ State __________________________________ Zip Code____________________
Bonding Company Name ______________________________________________________________________________________
Bonding Company Address ____________________________________________________________________________________
City ____________________________________ State __________________________________ Zip Code____________________
Architect/Engineer’s Name_____________________________________________________________________________________
Architect/Engineer’s Address ___________________________________________________________________________________
Mortgage Lender’s Name ______________________________________________________________________________________
Mortgage Lender’s Address ____________________________________________________________________________________
Permit Number___________________________
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in
this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL, PLUMBING, GAS, MECHANICAL, ROOFING,
SIGNS, POOLS, ETC.
OWNER’S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. ________________________________________________________
WARNING TO OWNER: Your failure to record a Notice of Commencement may result in your paying twice
for improvements to your property. A Notice of Commencement must be recorded and posted on the job site
before the first inspection. If you intend to obtain financing, consult with your lender or an attorney before
recording your Notice of Commencement.
Owner Signature ____________________________________________
The foregoing instrument was acknowledged before me this ___ /___ /___
by _______________________________ who is personally known to me
and who produced ___________________________________________
______________________________________ as identification and who
did not take an oath.
Contractor Signature __________________________________________
The foregoing instrument was acknowledged before me this ___ /___ /___
by _______________________________ who is personally known to me
and who produced ___________________________________________
______________________________________ as identification and who
did not take an oath.
Notary as to Owner _______________________________
Commission No. _____________________________________________
State of FL. County of _________________________________________
My Commission expires: _______________________________________
(SEAL)
Notary as to Contractor ___________________________
Commission No. ____________________________________________
State of FL. County of ________________________________________
My Commissi
on expires: ______________________________________
(SEAL)
Para más información en español, por favor llame al Departamento de Building Safety al número 407-836-5550.
43-75 (Rev 01/13) Page 2 of 2
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APPLICATION FOR P LUMBING PERMIT

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Completed 2 December 2020

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