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<br />PASCO COUNTY BUILDING PERMIT APPUCATlON <br /> <br />, Dade City: (004) 521-4206 <br />410 E, MeridaII 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'Lake& Blvd (US 41), Land O'Lakes <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK <br /> <br /> <br />:.:.:.:.:.:.:.;.:.;.:.:.;.;.;.:.:-:.:.:-.,>>>:.:.:.'';':':',' <br />.:.;.;.;.:.:.;.:.:.;.:.:-:.:.:.:.;.;.;........ . <br /> <br />,::Mmmm::::::;[:;~:~il:!illllllll!liiilj:lill~!l'::!~,:'.i:i'j'!!:.i.!!!':!l <br /> <br />CENTRAL PERMITTING OFFICES: <br /> <br />------------------------------------------ <br /> <br />j~~~7~:i~~ir~~~<fYYWWT OZ~;~5Yr <br /> <br /> <br />o <br />. FEE SIMPLE TITLEHOLDER'S NAME (If other thaII owner): <br />address (if applicable): CITY STATE ZIP <br /> <br />~~RIPTIO~F~RK:-~~~---------------------------- <br />8 UVING AREA: PATIO: t- GARAGE: ENTRY: TOTAL UNDER ROOF: <br />...J # BEDROOMS # BATHROOMS: _"_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br />co <br />5 <br />i= <br />0.. <br />a: <br />U <br />r./) <br />w <br />o <br /> <br /> . BONDING COMPANY: <br />::i:: ADDRESS: CITY STATE ZIP <br />g , ARCHITECT/ENGINEER: <br />...J <br />co <br />a: ADDRESS: CITY STATE ZIP <br />w <br />~ , MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br /> <br />. IF MOBILE HOME OR RV: MAKE <br />d\CVD <br />, WOR~ C,ODE: ~.-PLANS ON FILE?: <br /> <br />YEAR <br /> <br />SIZE <br /> <br />ONO <br /> <br />OYES <br /> <br />VALUATION: $ J (POD. 00 <br /> <br />--------------------------------- <br /> <br />-----~-~------~- <br /> <br />. CONTRACTOR: rrt . ) <br />SIGNATURE: <br />~ ADDRESS: . <br />9 STATE L1C # (If applicable): <br />co <br />~ 'ELECTRICAL CONTRACTOR: <br />t; SIGNATURE: PHONE#( )_- <br />~ ADDRESS: CITY STATE ZIP <br />~ STATE L1C # (if applicable): PASCO CO COMPUTER 101: <br />8 POWER CO: SAWPOLE: 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 COMPU:rER 101: <br />. (~Ulrad) <br /> <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 />WELL: <br /> <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~::.:.:...... <br /> <br />'OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE UC # (If applicable): <br />TYPE CONTRACTOR: <br /> <br />PHONE#( ) <br />CITY STATE ZIP <br />PASCO CO COMPUTER 10#: <br />VALUATION: $ <br /> <br />,~~....~...~;;.. 'i.I,,,,,/~, .~~ <br /> <br />>t <br /> <br /> <br />. . .. NOTiCE.... <br />BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND <br />SIGN THE REVERSE SIDE OF THIS APPUCATION <br />