|
<br />.
<br />.
<br />< .
<br />CENTRAL PERMITTING OFFICES:
<br />
<br />.
<br />
<br />PASCO COUNTY BUILDING PERMIT APPUCA nON
<br />SHADED AREAS FOR OFFICE USE ONLY
<br />
<br />--. -- ,.......... - .....,,,.,- .~. "fl."" ...~. ""
<br />. ....,..,..."".,.........."....",." :,...........,'.'.......'..'.'... ........'.'.. .."'............ .,.",
<br />'"::.':::::;:::::::':::::,:::;:,<::-:::,:.::,.:::::::::--::",-. :'<,;::.:: ".:: "'-'::.::::-:::-.' .:::::.-:: '>"'::::'.:.:.-. '-,-.<:"
<br />'.' ":::::<::;.:;::::::><\sea..::.<:: :' ,....:':.....:::;:.:::: ':.,-.::::>>':- .
<br />
<br />........, --- --. ....
<br />.._-". .. "'-'. - - . ... ,.,.-.
<br />.. .......- .... - - . - ..
<br />.... _d_'" ,..._ _ _ ..___.
<br />........, ......" -...
<br />. .oCClJPANCY:'
<br />.:,......'.NO.OF.lJNITS:
<br />'.....FIREPiSTRICT:.
<br />
<br />'-' ._-............ .............
<br />........-....-......, .-.-- ".
<br />.............................
<br />............ -". .,,,
<br />..,....-- '" . ..
<br />.-".-..... ,,- ,. ,.
<br />,,---....- -",. ,--.
<br />..,..:.-.-.:....'-- '","-_.",-.
<br />...-..... - - ..., '.'
<br />......... -- ". , , .
<br />....-_....... .,. "'.' - . --.
<br />-,,_......., -" -. '''..
<br />. ,. " "....
<br />...........,,--..,. . ...
<br />... ......-- -. ".
<br />........."-.... . .....-...
<br />................. . ...
<br />........-- -- .
<br />................, ,..- ".-'.-"
<br />........,.--.......... ....
<br />................... . .....
<br />..... "'" ...-- .
<br />.......".." -- .
<br />. -". -". - .
<br />...." ." ..
<br />...._-.-..,,-.. ....".
<br />. ",,-.. ...........
<br />...." ,," -.. ----- -- ...
<br />.."C:g;.................. .
<br />
<br />lil:
<br />9 . OWNER'S NAME:
<br />a:l JOB LOCATION:
<br />ffi PARCEL 10#: S
<br />Z OWNER'S PRES
<br />~
<br />o
<br />
<br />
<br />LOT O~O
<br />
<br />PHONE # ( 0' (3) 7:!tJ - ~
<br />SUBDIVISION: tV I tUJ
<br />PRdJ~6T~<ii> ..H LOT SIZE 5 x
<br />ClrY:/~ _STATE: r--'1... ZIP , /..'
<br />,
<br />
<br />
<br />, FEE SIMPLE TITLEHOLDER'S NAME (it other than owner):
<br />address (it applicable):
<br />
<br />. BONDING COMPANY:
<br />ADDRESS:
<br />
<br />
<br />, DESCRIPTION OF WORK:
<br />LIVING AREA:
<br />
<br />~
<br />g
<br />...J
<br />a:l
<br />Z
<br />o
<br />.-:
<br />n.
<br />5 . WORK cODE:fiiiimt.'w PLANS ON FILE? 0 NO 0 YES
<br />(/)
<br />w
<br />o
<br />
<br />
<br />VALUATION: $
<br />
<br />MO~ NAME:
<br />;) OOC -=---
<br />
<br />lil:
<br />o
<br />9 . ARCHITECT/ENGINEER:
<br />a:l
<br />a: ADDRESS:
<br />w
<br />~
<br />o
<br />
<br />CITY
<br />
<br />STATE
<br />
<br />ZIP
<br />
<br />CITY
<br />
<br />STATE
<br />
<br />ZIP
<br />
<br />. MORTGAGE LENDER:
<br />ADDRESS:
<br />
<br />CITY
<br />
<br />STATE
<br />
<br />ZIP
<br />
<br />. CONTRACTOR:
<br />SIGNATURE:
<br />ADDRESS:
<br />STATE L1C # 'it applicable):
<br />
<br />lil:
<br />o
<br />9
<br />a:l
<br />15 . ELECTRICAL CONTRACTOR:
<br />l3 SIGNATURE:
<br />~ ADDRESS:
<br />!z STATE L1C # (it applicable):
<br />8 POWER CO:
<br />
<br />PHONE # (
<br />CITY STATE ZIP
<br />PASCO CO COMPUTER ION:
<br />SAWPOLE: AMPS:
<br />
<br />. MECHANICAL CONTRACTOR:
<br />SIGNATURE:
<br />ADDRESS:
<br />STATE L1C # (it applicable):
<br />o NEW 0 ALTERATION VALUATION: $
<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 />PLUMBING
<br />FEE: $
<br />
<br />WELL:
<br />
<br />. OTHER CONTRACTOR:
<br />SIGNATURE:
<br />ADDRESS:
<br />STATE L1C # (it applicable):
<br />TYPE CONTRACTOR:
<br />
<br />
<br />$
<br />
<br />CITY
<br />
<br />PHONE # ( )
<br />STATE ZIP
<br />PASCO CO COMPUTER ION:
<br />VALUATION: $
<br />
<br />----------------------------------
<br />
<br />OTHER FEE TYPE:
<br />
<br />
<br />. RECEIPT#:
<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 />TOTAL BUILDING PERMIT FEE:
<br />
<br />(permit torm 10/91)
<br />
<br />EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF
<br />
<br />PC93043032
<br />
<br />. . .. NOTiCE....
<br />BOTH THE OWNER AND CONTRACTOR OF RECORD (License Holder) MUST READ AND
<br />SIGN THE REVERSE sloe OF THIS APPLICATION
<br />
|