APP-P
100 NW 1st Avenue Delray Beach FL 33444
(561) 243-7200 Fax: (561) 243-7221
Website: www.delraybeachfl.gov FOR OFFICE USE ONLY:
PROPERTY CONTROL #: ____-____-____-____-____-____-____
PLEASE PRINT:
JOBSITE ADDRESS ____________________________________________________________
PROPERTY OWNER NAME______________________________________________________
HOME PHONE (_______) ________________________ CELL (____) ______________________
PROPERTY OWNER ADDRESS __________________________________________________
PLUMBING CONT’R (COMPANY) NAME _________________________________________
PLUMBING CONT’R (COMPANY) ADDRESS ______________________________________
CITY__________________________________________ST___________ZIP________________
BUS. PHONE (_______) _________________________ CELL (____) _______________________
E-MAIL __________________________________________ FAX (_____) ____________________
NOTE: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180-DAYS OR IF ACTIVITY LAPSES FOR 180 DAYS. PLANS
MUST BE ON THE JOB SITE FOR ALL INSPECTIONS. FINAL INSPECTION IS REQUIRED ON ALL PERMITS.
DESCRIPTION OF WORK: _____RESIDENTIAL _____COMMERCIAL
TYPE OF INSTALLATION – CHECK ALL THAT APPLY:
________________________________ ____________________________ _________________ OR __________________
SIGNATURE OF QUALIFIER CONTR. REGISTRATION # WORKERS COMP # EXEMPT (FID /FEIN) #
STATE OF _______________________________________________________________
COUNTY OF _____________________
The foregoing instrument was acknowledged before me by means of [ ] physical presence or [ ] online notarization
this __DAY_____ day of _____MONTH_____________, __YEAR___ by _______________________________________
(Printed Name of Above Signatory)
______________________________________
Signature of Notary Public – State of Florida
(NOTARY SEAL)
GAS WORK: NEW _____ REPAIR/REPLACEMENT _____ GENERATOR _____
TYPE OF GAS: NATURAL: _____ L.P. _____ NUMBER OF OUTLETS: __________
SCOPE OF WORK ___________________________________________________________________________________
PROJECT COST (LABOR AND MATERIAL): $_______________________
FIRE SPRINKLER: (2 SETS OF PLANS REQUIRED)
NUMBER OF HEADS __________ NEW _____ REPAIR/REPLACEMENT/RELOCATION _____
PROJECT COST (LABOR AND MATERIAL): $_______________________
GENERAL PLUMBING: NEW _____ REPAIR/REPLACEMENT _____
WATER HEATERS: ELECTRIC _____ GAS _____
WATER CONNECTION: _____ BACKFLOW INSTALLATION: FIRE ____ IRRIGATION ____ OTHER _____
SEWER CONNECTION: _____
SOLAR PANEL INSTALLATION: _____
SCOPE OF WORK (Describe WORK and LOCATION: Kitchen/Bedroom/Garage, etc):
____________________________________________________________________________________________________
PROJECT COST (LABOR AND MATERIAL): $ ______________________
PLUMBING PERMIT APPLICATION
(INCLUDES GAS AND FIRE SPRINKLER)
BLDG PERMIT #: ________________
PLBG PERMIT #: ________________
PERMIT FEE: ________________
PLAN CHECK FEE: ______________
MCR #: ________________
********************************
APPROVALS:
PLBG: _________ DATE: _________
FIRE: _________ DATE: _________
UTILITIES: _____ DATE: _________
Personally Known _____
OR
Produced Identification _____
Type of Identification Produced
_________________________________
REV 5/2023