Laserfiche WebLink
<br />).3616 <br /> <br />PASCO COUNTY BUILDING PERMIT APPUCA nON <br />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 /' <br />. Land O'Lakes: (813) 929.6Qii.. 12- t;.fwIo' <br />9930 Land O'Lakes Blvd, (US 41), Land O'Lakes <br /> <br />THIS APPUCATION MUST BE TYPED OR PRINTED IN INK <br />AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS .... ...... <br />-----------------------~------------------ <br /> <br /> <br /> <br />i~~t~f~!t:~t~~g:;~~q~~~~~;.x- <br /> <br /> <br />o <br /> <br />. FEE SIMPLE T~TLEHOLDER.S NAME (II other than owner): <br />address (II applicable): CITY STATE ZIP <br /> <br />~ESCRIPnONOF~~---~-K~F-------------------------- <br />~ UVING AREA: PAnO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br />g , BEDROOMS , BATHROOMS: _-_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br />10 <br />5 <br />~ <br />c.. <br />a: <br />o <br />l/) <br />W <br />Q <br /> <br />.......... ............ <br />:::::::;':.;';:::;:;'::::::::::::::::;::::::..:::;",:: :...::....../f~r::::::t~\t\;~...i ::;:: .::::: ::~<:::. :', <br /> <br />Ijl'lli'Jli~~jl;lil~II~~illiliillllli,jiil:!::i:!!,!!:lijijij::,:!!:.!!i!!i'!:,!!,'!,;,,:,!,;!'!!!i;;!!,i!,;,I!':::!;!~[I <br /> <br /> <br />'IF MOBILE ~E ~R~MAKE <br /> <br />. WORK CO~PLANSON FILE? <br />MODEL NAME: <br /> <br />YEAR <br /> <br />SIZE <br /> <br />o NO 0 YES <br /> <br />VALUATION: $ <br /> <br />Lf 2. 4&. tPI.7 <br /> <br />----------------------~---------- <br /> <br /> . BONDING COMPANY: <br />.SC ADDRESS: CITY STATE ZIP <br />9 . ARCHITECT/ENGINEER: <br />10 CITY STATE_ZIP <br />a: ADDRESS: <br />w <br />i= . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />--------------------------------- <br /> <br />, CONTRACTOR: <br />SIGNATURE: <br />::.: ADDRESS: <br />9 STATE L1C, (il applicable): <br />10 <br />a: <br />e <br />~ <br />a: <br />~ <br />z <br />o <br />o <br /> <br />PHONE' ( <br />. CITY STATE ZIP <br />PASCO CO COMPUTER 10#: <br /> <br />. ELECTRICAL CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE UC , (if applicable): <br />POWER CO: <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 UC, (il 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 UC , (it applicable): <br />, FIXTURES: . SEPTIC PER #: <br /> <br />PHONE # ( <br />STATE ZIP <br />PASCO CO COMPUTER 10': <br />SEWER: WATER: <br /> <br /> <br />, OTHER CONTRA TO <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C, (If applicable): <br />TYPE CONTRACTOR: J( i''';() F, ',<, J , <br /> <br /> <br />( <br />PHONE'(~ 7fl.l- hCJ~~ <br />7: - I C STATE ZIP J J S""'1.f I <br />PASCO CO COMPUTER 10': . 2 / <br />VALUATION: $ l.j 2.. "e;;. e:".e; <br /> <br />- - - - - - - - - - - - - - - - - -- - - - -- - - - - - -- -- ~..:..; <br /> <br />OTHER FEE TYPE: <br /> <br />JOBS UNDER $2.500 IN VALUE DO NOT NEED TO <br />RECORD AND POST A "NOTICE OF COMMENCEMENr <br /> <br />". "'. ....... ",' : ",... <br /> <br />. TOTAL BUILDING PERMIT FEE: <br /> <br />(permit lorm 10/91) <br />EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACQEPTED BY CENTRAL PERMITTING STAFF <br /> <br />PC93043032 <br /> <br />. . "" NOTiCE""." <br />BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND <br />SIGN THE REVERSE SIDE OF THIS APPLICATION <br />