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<br />/ <br />/ <br />/ <br /> <br />'., <br /> <br />PASCO COUNTY 8UILDING PE~MIT APPUCATlON <br />r SHADED AREAS FOR OFFICE USE ONLY <br /> <br />CENTRAL PERMITTING OFFICES: <br /> <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 Little Road, New Port Richey t~12' 929-f2S6 <br />. Land O'Lakes: (813) 929-6085 -0 <br />l\ \ \ \ .. Land O'Lakes Blvd, (US 41), Land O'Lakes <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK <br />AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS <br />------------------------------------------ <br /> <br />8 . OWNER'S NAME: tA)A(lt1~~O)A) i oS <br />~ JOB LOCATION: gq ~ S 'If ,Atllr <br />a: PARCEL 101: S T R SUB BLK <br />~ OWNER'S PRESENT ADDRESS: ~9 S'~:r 971>1 <br />~ <br />o <br /> <br />LOT <br />A~~ <br /> <br /> <br />, FEE SIMPLE TITLEHOLDER'S NAME (It other than owner): <br />address (It applicable): <br /> <br />----------~-IT------~--------------------- <br />. DESCRIPTION OF WORK: crl...SJ IC~o O~ "5 r, lr AI~ fiA4 <br />LIVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br /># BEDROOMS , SA THROOMS: _0_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br /> <br />CITY <br /> <br />STATE <br /> <br />ZIP <br /> <br />:lC: <br />g <br />...J <br />CD <br />~ . IF MOBILE HOME OR RV: MAKE <br />1= <br />a.. <br />a: <br />o <br />In <br />W <br />o <br /> <br />. MECHANICAL CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C , (it applicable): <br />o NEW OALTERATION VALUATION: $ <br /> <br /> <br />YEAR <br /> <br />SIZE <br /> <br />. WORK CODE: _ PLANS ON FILE? 0 NO 0 YES <br />MODEL NAME: <br /> <br /> <br />VALUATION: $ Q1SDO. D'U <br /> <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -:=::';: <br /> <br /> . BONDING COMPANY: <br />:lC: ADDRESS: CITY STATE ZIP <br />0 <br />9 . ARCHITECT/ENGINEER: <br />CD CITY STATE ZIP <br />a: ADDRESS: <br />w <br />i= , MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />, CONTRACTOR: <br />SIGNATURE: <br /> <br />PHONE' ( <br /> <br />:lC: <br />9 <br />CD <br />a: <br />g <br />o <br />cC <br />a: <br />.... <br />z <br />o <br />o <br /> <br /> <br />AMPS: <br /> <br />PHONE # ( <br />CITY STATE <br />PASCO CO COMPUTER ION: <br />(Required) <br /> <br />ZIP <br /> <br />, PLUMBING CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: CITY <br />STATE L1C # (it applicable): <br /># FIXTURES: - SEPTIC PER ,: <br /> <br />PHONE # ( <br />STATE ZIP <br />PASCO CO COMPUTER ION: <br />SEWER: WATER: <br /> <br /> <br />WELL: <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 PERMIITING STAFF <br /> <br />PC93043032 <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 />