Fillable Form 1: Plumbing/Gas Permit Application (City of Orlando)

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Form 1: Plumbing/Gas Permit Application (City of Orlando)

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  • 21 check-boxes
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File type: PDF

U.S.A. forms for City of Orlando

BROWSE CITY OF ORLANDO (FL) FORMS

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Plumbing/Gas Permit Application
*For digital plans review, please email this application to digitalpermits@orlando.gov
Projects utilizing Private Provider require submittal and application via our Private Provider application service page.
Date:
Related Building Permit # (if applicable):
Job Site Address, Parcel ID # or Legal Description:
Owner Name, Address, Phone:
Contractor Name
1
, Address: Lic#:
Contractor Company Name
1
, Address:
1
Current license and insurance information must be registered with Permitting Services or provided with this application.
Digital Plans Applicant Name:
Company:
Phone:
Email:
Primary Contact: Job/Project Name:
For Contractor and Primary Contact, do we have current Phone #, FAX # and email address?
Work Description:
GENERAL
Type of Work (subtype - select one):
Addition Alteration
Gas Piping Irrigation
2
New Structure
Solar
Repair/Replace
Sewer Connection Accessory Structure
Abandon Grease Traps/Interceptor
2
Backflow prevention device is required for Irrigation.
Plan Review Type:
Commercial
Residential 1 or 2 Unit Residential 3 or More Units
Irrigation Source:
City
Not Applicable Reclaimed Well Lake
# New Sewer Connections: # Plumbing Fixtures:
Water Service?
Related to Code Enforcement Action? (Y/N) Estimated Construction Cost: $
Note: Owner furnished equipment and materials must be included in Estimated Construction Cost. If the estimated
cost of this job is greater than $2,500 and not related to a Building Permit, a certified copy of the recorded Notice
of Commencement must be filed in the Office of Permitting Services prior to scheduling your first inspection. FS
713.135(d).
GAS INFORMATION
ECONOMIC DEVELOPMENT • PERMITTING SERVICES
400 South Orange Avenue · First Floor PO Box 4990 · Orlando, FL
32802-4990 P
407.246.2204· F 407.246.3420 · Orlando.gov/permits
Type of Gas:
Natural
LP
Medical
3
(indicate State Certification # in work description above)
# of Gas Outlets:
Page 1 of 2
Updated 2/20
FIXTURES
Bathtub
Bidet
Cooking Range – Gas
Dental Unit
Dishwasher
Disposal
Drinking Fountain
Dryer - Gas
Fireplace – Gas
Floor Drain
Floor Sink
Grill – Gas
Hub Drain
Interceptor
Lavatory
Roof Drain
Room Heater – Gas
Shower Stall
Sink – Commercial
Sink – Kitchen
Sink – Mop 3” Drain
Sink – Service P Trap
Special Fixture
Special Fixture – Gas
Unit Heater – Gas
Urinal
Washing Machine
Water Closet
Water Heater – Electric
Water Heater – Gas
Qty
Qty
Qty
48 Hours before you dig call SUNSHINE 1.800.432.4770. It's the Law in Florida.
I hereby acknowledge that I have read this application and state that the above information is
correct. I also agree to conform to all City Ordinances regulating gas and plumbing work.
Owner/Contractor/Agent: Date:
Print Name:
NOTARIZED OWNER SIGNATURE REQUIRED ONLY IF THIS WORK IS NOT
PART OF A PROJECT WITH AN ISSUED BUILDING PERMIT.
Owner: Date:
Print Name:
(Owner)
(Owner)
STATE OF FLORIDA
COUNTY OF ___________________
SWORN to and subscribed freely and voluntarily for the purpose therein expressed before me by
_
____________________________, known to me to be the person described in and who executed
the foregoing. He/she is personally known to me or has produced
_______________________________ (type of identification) as identification.
WITNESS my hand and official seal in the County and State last aforesaid this ________ day of
_____________________, 202__.
_______________________________________
Notary Public Signature
Print Name:
My Commission Expires:
OWNER’S ELECTRONIC SUBMISSION STATEMENT:
Under penalty of perjury, I declare that all the information contained in this building permit application is true and
correct.
For plan review status, inspection scheduling/results and other permitting information, please call
“PROMPT”, our Interactive Voice Response system at 407.246.4444 or visit online at orlando.gov/permits.
ECONOMIC DEVELOPMENT • PERMITTING SERVICES
400 South Orange Avenue · First Floor PO Box 4990 · Orlando, FL
32802-4990 P
407.246.2204· F 407.246.3420 · Orlando.gov/permits
Page 2 of 2
Updated 2/20
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Form 1: PlumbingGas Permit Application (City of Orlando)

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Completed 26 February 2021

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