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<br />CENTRAL F ERMITTING 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 Uttle Road, New Port Richey <br />. Land O'Lakes: (813) 996-2203 <br />9930 Land O'Lakes Blvd (US 41), Land O'L.akes <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK <br />AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS <br />------------------------------------------ <br /> <br /> <br />~ .~N:~,:::::.f}J;O+plr1Jd,{_ivm~~. ... SUB;,';~;I;fWIli]:~;:/3 <br />~ ~:NCEE~~O:~~~A~;~: * 1~~ "'('A:d~: /J~T / I.3P6~C~~;;;;/;".,'>>T~;;:~~:L kSIZE~:;;~ <br /> <br />o <br />. FEE SIMPLE TITLEHOLDER'S NAME (If other than owner): <br />address (If applicable): CITY STATE ~ZIP <br /> <br />~scmn;-o;; OF WORK -:r,; ~ -; i.i - ;;X:n;- -;-~~ - /I-:"'-*,- -(iYfi:Ti.~.i: -r.;;;;;. r."'k - - - - <br />g LIVING AREA: PATIO: GARAGE: ENTR , TOTAL UNDER ROO . <br />..J # BEDROOMS # BATHROOMS: _-_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br />III <br />z <br />o <br />1= <br />D. <br />a: <br />() <br />1Il <br />W <br />o <br /> <br /> <br />. IF MOBILE HOME OR RV: MAKE <br /> <br />YEAR <br /> <br />SIZE <br /> <br />. WORK CODE: _ PLANS ON FILE? <br />MODEL NAME: <br /> <br />VALUATION: $ I 7 c1~S- * <br /> <br />ONO OYES <br /> <br /> . BONDING COMPANY: <br />llC ADDRESS: CITY STATE ZIP <br />() <br />0 . ARCHITECT/ENGINEER: <br />..J <br />III <br />a: ADDRESS: CITY STATE ZIP <br />w <br />~ <br />l- . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />'CONTRACTOR:~rn~~o . i;{;J-Lllh""4/'UM.o <br />SIGNATURE: ~ / PHONE#( '()'/)&? -m <br />~ ADDRESS: /CJ - ITY' e1~ STATE ~ ZIP 3.30("'- <br />9 STATE L1C # (if applicable): PASCO CO COMPU ER ION: _ _~ ? <br />III <br />a: <br />g <br />() <br />< <br />a: <br />I- <br />z <br />o <br />() <br /> <br />. ELECTRICAL CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />POWER CO: <br /> <br />PHONE # ( <br />CITY STATE <br />PASCO CO COMPUTER 10*: <br />SAWPOLE: <br /> <br />ZIP <br /> <br />AMPS: <br /> <br />. MECHANICAL CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />o NEW 0 ALTERATION 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 applicable): <br /># FIXTURES: - SEPTIC PER #: <br /> <br />PHONE # ( <br />STATE ZIP <br />PASCO CO COMPUTER 10*: <br />SEWER: WATER: <br /> <br />, OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />TYPE CONTRACTOR: <br /> <br /> <br />WELL: <br /> <br />PHONE # ( ) <br />CITY STATE ZIP <br />PASCO CO COMPUTER 10*: <br />VALUATION: $ <br /> <br />, ., . . <br />.. ..... . <br />.. ..... <br />, , <br />---------------------------------~~.. <br /> <br />JOBS UNDER $2,500 IN VALUE DO NOT NEED TO <br />RECORD AND POST A "NOTICE OF COMMENCEMENT" <br /> <br />(permit form 10/91) <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 />