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<br />PASCO COUNTY BUILDING PERMIT APPUCATlON <br />SHADED AREAS FOR OFFICE USE ON <br /> <br />/ .-.. ~ r-, '1- <br />f - 1 , --". <br />C;;.c(.';,i- . <br />,;).:/5- J")/! <br /> <br />CENTRAL PERMITTING OFFICES: <br /> <br /> <br />....:.:-:.:.;.:-:-:.......:.:;>..;...;....-:.>-:.....-:.:-:-:-:-::.;.:-: <br />. ........ . "... . .... ...... <br /> <br />...........~g?g~ctm:............ <br /> <br />(:FIRE.oisTRlcr.::: <br /> <br />. Dade City: (904) 521-4206 <br />37918'Meridian Ave., Rm 234, Dade City <br />. New Port Richey: (813) 847-8126 <br />7432 Little Road, New Port Richey <br />· Land O'Lakes: (813) 929-1266 <br />4111 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 />i .~;:Le;~~~~~~: 1::!J/LJ -;~~~~'~ ~~.~UB;I';;?~(f~~~jt~&~. .1J~S'IItJ <br />~ ~:NCEE~~O:~~~A~~:~l~~ 1~~j:;-LOT/, '-'~p~~c~;;;,;;~~~~;A~:LO~ZE~~7$p <br /> <br />o <br />. FEE SIMPLE TITLEHOLDER'S NAME (If other than owner): <br />address (if applicable): CITY STATE ZIP <br /> <br />:DESCR I P:;ON OF WORK: - ;;-A/-;'5"it,,;;~- -:i:'R,t}~-; - a.;;J.,-A.~7z - -'l;JZ1~'- - - -- - - - -- <br />g LIVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br />..J # BEDROOMS #BATHROOMS:_-_ TYPE CONSTRUCTION: o BLOCK OFRAME o OTHER: <br />III <br />z <br />o <br />i= <br />a.. <br />a: <br />o <br />Ul <br />w <br />o <br /> <br />. MECHANICAL CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />o NEW 0 ALTERATION VALUATION: $ <br /> <br /> <br />. IF MOBILE HOME OR RV: MAKE ./ <br /> <br />. WORK CODE: ~\_ PLANS ON FILE? 0 NO ~ <br />MODEL NAME: <br /> <br />YEAR <br /> <br />SIZE <br /> <br />VALUATION: $ ~ ff'J 1. , ~ <br /> <br />... ...n.... <br />. . . . . . . . . . . . . . . . . . . . . .. .. ..... <br />........................ ...... <br />.................... ...... <br />. ......... .............. <br /> <br /> . BONDING COMPANY: <br />~ ADDRESS: CITY STATE ZIP <br />0 <br />9 . ARCHITECT/ENGINEER: <br />III <br />lC ADDRESS: CITY STATE ZIP <br />w <br />i= . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />~ <br />9 <br />III <br />e . ELECTRICAL CONTRACTOR: <br />o SIGNATURE: <br />~ ADDRESS: <br />~ STATE L1C # (if applicable): <br />8 POWER CO: <br /> <br />PHONE # ( <br />CITY STATE ZIP <br />PASCO CO COMPUTER 10.: <br />SAWPOLE: AMPS: <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 /> <br /> <br />. OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br />TYPE CONTRACTOR: <br /> <br />PHONE # ( ) <br />CllY STATE ZIP <br />PASCO CO COMPUTER 10.: <br />VALUATION: $ <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 /> <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 (Ucense Holder) MUST READ AND <br />SIGN THE REVERSE SIDE OF THIS APPLICATION <br />