Orange Form 23 14 – Fill Out and Use This PDF

Orange County Division of Building Safety

201 SOUTH ROSALIND AVENUE

Reply To: Post Ofice Box 2687 • Orlando, Florida 32802-2687 DATE

Phone 407-836-5550 • Fax 407-836-2852 • Inspections ONLY: 407-836-2825

Building Permit Number

APPLICATION FOR PLUMBING PERMIT

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.”

PLEASE PRINT

The undersigned hereby applies for a permit to make plumbing installations as indicated below on property. Owned by:

Street Address

City

State

Zip Code

Phone No.

-

-

Method of Payment: Cash r

Check r

Escrow r

Job Information: Lot No.

Block

Subdivision Name

Tax Identiication Number: Section

Township

Range

Subdivision

Lot

(15 Digit Number:)

STREET ADDRESS

City

STATE

Zip Code

Phone No.

-

-

Class of Building: OLD r

New r

Type of Building: Residential (028) r

Commercial (029) r

Mobile Home (006) R

Type of Work: New (001) r Addition (004) r Alteration (003) r Repair (002) r Type of System: Sewer r Septic r Re-pipe r

Date First Inspection Desired:

or will call r VALUATION OF JOB

(Valuation of all materials, labor, & ixtures installed)

FIXTURES

NUMBER

FEE

FIXTURES

NUMBER

FEE

Dishwashers

Water Closets ( Toilet)

Bathtubs

Laundry Tubs

Urinals

Floor Drains

Disposals

Grease Traps

Washing Machines

Trailer Connections

Water Heaters

Spa

Sewer

Solar

Catch Basins/Sumps

Pool Piping

Service Sink

Irrigation:

(No. Systems

No. Heads)

Lavatory (Bathroom Sink)

Water Softener

Showers

Re-pipe

Miscellaneous

Sinks

(Specify)

Total Fees

Total Fees

I hereby certify that the above is true and correct to the best of my knowledge.

Grand Total Fees

PLEASE PRINT

Name of Active Certiicate Holder (Master Plumber)

State Registration or Certificate Number (Master Plumber)

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.

Authorized Signature (License Holder or Agent)
Street Address
City	STATE	Zip Code	Phone Number	-	-

NOTE: The Building Permit Number is required if the Plumbing Installation is associated with any construction or alteration where a Building Permit has been issued.

THIS APPLICATION WAS TRANSMITTED BY FACSIMILE ON			.
	(Date/Time)
23-14 (REV. 2/10)	Plumbing Permit Number