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<br />CENTRAL FERMITTI~G OFFICES: <br /> <br />PASCO COUNTY BUILDING PERMIT APPUCATION <br /> <br />.. . .~~~~~~~~~~~~.i' .........,. ...... <br />.........~g~~;t%ri~:................................................>~t9,~..............;~t <br />>FIREpiSTflI9J: ...rEAMIT~: . <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 UltIe Road, New Port Richey TYPE CONSTRUrlON' II iii Iv v vi <br />. Land O'Lakes: (813) 996-2203 ( <br />9930 Land O'Lakes Blvd (US 41), Land O'Lakes DATE REC E B ' <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK I ~ <br />AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS . . <br />------------------------------- ---------- <br /> <br /> <br /> <br />8 'OWNER'S NAME: I' PHONE # (8'1 J ) 7&3 - 6'" ~., <br /> <br />2t:NS~~::beiu~ ~_~~i~'~~~...%~lt~6:~.LO~t:.1ux~~ <br /> <br /> <br />address (if applicable): CITY STATE ZIP <br /> <br />~ <br />8 <br />-l <br />10 <br />Z <br />o 'IF MOBILE HOME OR RV: MAKE <br />~ <br />Q. <br />a: <br />o <br />lJ) <br />w <br />o <br /> <br /> <br />. DESCnlPTION OF WORK: <br />LIVING AREA: <br /># BEDROOMS . '3 <br /> <br />TOTAL UNDER ROOF: /650 <br />o FRAME 0 OTHER: <br /> <br />--------------------------------- <br /> <br /> <br />'Flee- tWOOIJ <br /> <br />YEAR q'f SIZE;Lr )( 60 <br /> <br />VALUATION: $ I...~ <br /> <br />w~~ <br /> <br /> <br />. WORK CODE:::::::~i~::~::::::~:f:~l~~i:~i:::j PLANS ON FILE? 0 NO 0 YES <br />MODEL NAMESifouu;f~'-I'f <br /> <br />--------------------------------- <br /> <br /> . BONDING COMPANY: <br />~ ADDRESS: CITY STATE ZIP <br />0 <br />0 . ARCHITECT/ENGINEER: <br />-l <br />10 <br />a: ADDRESS: CITY STATE ZIP <br />w <br />~ <br />l- . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />~ <br />9 <br />10 <br />a: <br />o <br />I- <br />o <br />< <br />a: <br />I- <br />Z <br />o <br />o <br /> <br />PHONE# (8'13 ) 7~~ .bC>'iJ7 <br />STATE51 I ZIP J ~S'T.1 <br />COMPUTER 10#: oCJ :;>'7Y/ <br /> <br />. MECHANICAL CONTRACTO <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />o NEW OALTERATION <br /> <br />VALUATION: $ <br /> <br />. PLUMBING CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br /># FIXTURES: <br /> <br /><OWN ~fl---- <br /> <br />PHONE # ( <br />CITY STATE <br />PASCO CO COMPUTER 10#: <br />- SEPTIC PER #: SEWER: WATER: <br /> <br />PLUMBING <br />FEE: $ <br /> <br />ZIP <br /> <br /> <br />WELL: <br /> <br />. OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />TYPE CONTRACTOR: <br /> <br />CIIY <br /> <br />PHONE # ( <br />STATE <br />PASCO CO COMPUTER 10#: <br /> <br />OTHER FEE TYPE: <br /> <br />AMOUNT:S . <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 form 10/91) <br />EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF <br /> <br />. · .. NOTiCE.... <br />BOTH THE OWNER AND CONTRAC.'TOR OF RECORD (License Holder) MUST READ AND <br />SIGN THE REVE~SE SIDE OF THIS APPLICATION <br />