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2. Date
   Date
3. Check one*

   1. Commercial
   2. Residential
   3. Irrigation
4. Meter size*
6. Legal Description
7. Property Address*
9. Owner or Authorized Representative*
10. Mailing Address*
12. Phone
13. Email*
15. 7th Edition (2020) Florida Plumbing Code Applies
    IRRIGATION METERS ONLY: Irrigation meters will be placed next to present meter only. Appointment cannot be made for installation. Homeowner will be responsible for installing systems to meter.
17. Name of firm and mailing address:
18. Person responsible for Bill:
20. Email Address:
21. Phone No.
23. Signature

    By typing your name here, you are signing this form electronically. You agree you are submitting this affidavit for processing and is the legal equivalent of your manual signature on this form. You must be the legal business owner or authorized agent which match our registration records. Note: A notarized Letter of Authorization is required for an agent to sign the application or any other correspondence that calls for an agent signature.

25. Square Foot Bldg
26. This building will be sprinkled:

    1. Yes
    2. No
27. Is there a fire hydrant on this property:

    1. Yes
    2. No
29. Permit No.
30. Permit Fees Due: $
31. Receipt No.
32. Total Amount Rec'd
34. Work Order No.
35. Security Deposit
36. Date:
    Date:
38. Water Impact Fee
39. Sewer Impact Fee
40. Water Connection
41. Sewer Connections
43. Number of ERU's
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field