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<br />PASCO COUNTY BUILDING PERMIT APPUCATION <br /> <br />CENTRAL PERMITTltiq OFFICES: <br /> <br />. Dade City:' (904) 521-4206 <br />410 E, Meridan Ave, Rm 234, Dade City <br />, New Port Richey: (813) 847-8126 <br />7432 Utile Road. New Port Richey <br />. Land O'Lakes: (813) 996-2203 <br />9930 Land O'Lakes Blvd (US 41). Land O'Lakes <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK <br /> <br /> <br />------------------------------------------ <br /> <br />lll: <br />9 , OWNER'S NAME: <br />III JOB LOCATION: s 2' b <br />ffi PARCEL 10#: s..3.5::..- T ~ R ~ SUB 00..0)/9 BLK <br />~ OWNER'SPRESENTADDRESS: 38S'/9 7rd/is .5f <br /> <br />o <br /> <br /> <br />. FEE SIMPLE TITLEHOLDER'S NAME (if other than owner): <br />address (if applicable): CITY STATE ZIP <br /> <br />:-;)ESCRIPTlON OF WORK - jJ,,"7,ii if / ~ ;-;;:- -;fA;;; ~ ~1!'; Xi 51-fnj -st"{f[ - - - ~ - -- <br />lll: LIVING AREA: PATIO: GARAGE: E Y:. TOTA UNDER ROO~~ <br />9 # BEDROOMS # BATHROOMS: _-_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br />III <br />z <br />o <br />i= <br />Q. <br />iC <br />o <br />II) <br />W <br />Q <br /> <br />. CONTRACTOR: <br />SIGNATURE: <br />lll: ADDRESS: <br />9 STATE L1C # (if applicable): <br />III <br />e . ELECTRICAL CONTRACTOR: <br />~ SIGNATURE: <br />II: ADDRESS: <br />~ STATE L1C # (if applicable): <br />8 POWER CO: <br /> <br /> <br />. IF MOBILE HOME OR RV: MAKE <br /> <br />YEAR <br /> <br />SIZE <br /> <br />. WORK CODE: <br /> <br />PLANS ON FILE?: 0 NO <br /> <br />~ES <br /> <br /> <br />VALUATION: $ <br /> <br />19~" ~ <br /> <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- <br /> <br /> . BONDING COMPANY: <br />.~ ADDRESS: CITY STATE ZIP <br />9 . ARCHITECT/ENGINEER: <br />III <br />II: ADDRESS: CITY STATE ZIP <br />w <br />i!: . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- <br /> <br /> <br />PHONE#( 90'/) Sic 7 () -?()3 <br />STATE ft: ZIP 33.(".....) " <br />TER 10#: ',( 7 , <br /> <br />PHONE # ( <br />CITY STATE ZIP <br />PASCO CO COMPUTER 10#: <br />SAWPOLE: AMPS: <br /> <br />. MECHANICAL CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />ONEW OALTERATION VALUATION: $ <br /> <br />PHONE # ( <br />CITY STATE <br />PASCO CO COMPUTER 10#: <br />(Required) <br /> <br />ZIP <br /> <br />. PLUMBING CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: CITY <br />STATE L1C # (if appl1cable): <br /># FIXTURES: - SEPTIC PER #: <br /> <br />PHONE # ( <br />STATE ZIP <br />PASCO CO COMPUTER 10#: <br />SEWER: WATER: <br /> <br />WELL: <br /> <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- <br /> <br />. OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />TYPE CONTRACTOR: <br /> <br />PHONE # ( ) <br />CITY STATE ZIP <br />PASCO CO COMPUTER 10#: <br />VALUATION: $ <br /> <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- <br /> <br />RECEIPT#: <br /> <br />JOBS UNDER $2,500 IN VALUE DO NOT NEED TO <br />RECORD AND POST A "NOTICE OF COMMENCEMENr <br /> <br />(permit form 4/91) <br />EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF <br /> <br />.... NOTiCE.... <br />BOTH THE OWNER AND CONTRACTOR OF RECORD (License Holder) MUST READ AND <br />SIGN THE REVERSE SIDE OF THIS APPLICATION <br />