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<br />PASCO COUNTY BUILDING PERMIT APPUCATlON <br />SHADED AREAS FOR OFFICE USE ONLY <br /> <br />CENTRAL F ERMIITING 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'I..ak8s: ( - <br />9930 Land O'I..ak8s Blvd (US 41), Land O'I.ak86 <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK <br />AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS <br />------------------------------------------ <br /> <br />lll:: <br />~ <br />CD <br />II: <br />W <br />Z <br />~ <br />o <br /> <br /> <br />. FEE SIMPLE TITLEHOLDER'S NAME (If olher than owner): <br />address (If applicable): CITY STATE ZIP <br /> <br />~ESCnl~IONOF~~B~~~~-~~~r-~Zd~T~I---------------- <br />l:5 LIVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br />9 # BEDROOMS # BATHROOMS: _-_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br />CD <br />z <br />o <br />F= <br />a. <br />a: <br />o <br />III <br />W <br />o <br /> <br /> <br />. IF MOBILE H~~_ <br /> <br />, WORK CO~~NSON FILE? <br />MODEL NAME: <br /> <br />'{EAR <br /> <br />SIZE <br /> <br />o NO 0 YES <br /> <br />VALUATION: $ <br /> <br />I cni.. 00 <br /> <br /> . BONDING COMPANY: <br />lll:: ADDRESS: CITY STATE ZIP <br />0 <br />9 . ARCHITECT/ENGINEER: <br />CD <br />II: ADDRESS: CITY STATE ZIP <br />w <br />i= . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />. CONTRACTOR: Cr~ 12 tU:l.f~;r I X" (. - <br />SIGNATURE:~ ~ - . - PHONE# ( q O~) S- J>.r . '54" socr <br />lll:: ADDRESS: p..o, (!;(\J( 'l.~D CITY ~h.A. A^/~A"D STATE Fl. ZIP ~~S-'6 <br />9 STATE L1C # (if applicable): PASCO CO COMPUTER 101: "1/0Y <br />CD <br />II: <br />e <br />o <br />< <br />II: <br />.... <br />Z <br />o <br />o <br /> <br />. ELECTRICAL CONTRACT.OR: <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 />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 applicable): <br /># FIXTURES: . SEPTIC PER #: <br /> <br />PHONE # ( <br />STATE ZIP <br />PASCO CO COMPUTER 10.: <br />SEWER: WATER: <br /> <br />WELL: <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 />OTHER FEE TYPE: <br /> <br /> <br />-------------------------------- <br /> <br />JOBS UNDER $2,SC';O 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 />" " .. NOTiCE."." <br />BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND <br />SIGN THE REVERSE SIDE OF THIS APPLICATION <br />