APP-PPLUMBING PERMIT APPLICATION
(INCLUDES GAS AND FIRE SPRINKLER)
100 NW 1' Avenue Delray Beach FL 33444
(561) 243-7200 Fax: (561) 243-7221
Website: mydelrgybeach.com
PROPERTY CONTROL #:
FOR OFFICE USE ONLY:
BLDG PERMIT #
PLBG PERMIT #5 PLEASE PRINT:
JOBSITE ADDRESS PERMIT FEE
PLAN CHECK FBE PROPERTY OWNER NAME
HOME PHONE MCR #: CELL *****p ******#
PROPERTY OWNER APPROVALS
PLUMBING CONTR (COMPANY) NAME High Tide Plumbing Services PLBG DATE
PLUMBING CONT'R (COMPANY) ADDRESS 264 S Military Drive FIRE DATE
CITY Deerfield Beach ST FL 33442 ESD DATE ZIP
BUS. PHONE CELL 561. 313.4160
FAX
h2o@hightideplumbing. E-MAIL com
NOTE: PERMIT EXPIRES IE 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:
GENERAL PLUMBING REPAIR/REPLACEMENT NEW
WATER HEATERS BLECTRIC GAS
SEWER CONNECTION WATER CONNECTION
SOLAR PANEL INSTALLATION
SCOPE OF WORK (Describe WORK and LOCATION: Kitchen/Bediroom/Garage, etc)
PROJECT COST GLABOR AND MATERIAL:
SPRINKLER (3 SETS OF PLANS REQUIRED)
BER OF HEADS NEW REPAIR/REPLACEMENT/RELOCATION
JECT COST (LABOR AND MATER
GAS WORK NEW REPAIR/REPLACE MENT GENERATOR TYPE OF GAS: NATURAL L.P NUMBER OF OUTLETS
SCOPE OF WORK
PROJECT COSTLLABOR AND MATERIAL)
CFC1426268
45. -5468916 SIGNATURE OR
CONTR, REGISTRATI ON # WORKERS COMP # i
EXEMPT (FID /FEIN) # r
N
i STATE OF xmires
COUY TY OF
Personally Known
The foregoing instrument was acknowledged before me day OR
Produced Identification
Produced
TERESA SCHNE
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Signature2 Commi blic
CFA
Ju! *C. 2024
Bonded through Nationai Notary 455r
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