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, . ' PASCO COUNTY BUILDING PERMIT APPUCA nON SHADED AREAS FOR OFFICE USE ONLY CENTRAL PERMITTING OFFICES: . Dade City: (904) 521-4206 37918 Meridian Ave., Rm 234, Dade City . New Port Richey: (813) 847-8126 7432 Little Road, New Port Richey · Land O'Lakes: (813) 929-1266 4111 Land O'Lakes Blvd. (US 41), Land O'Lakes THIS APPLICATION MUST BE TYPED OR PRINTED IN INK AND IS VOID IF ~T PERM..!.TTED ~1!t!.1~ ~~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ----- . OWNER'S NAME: . FEE SIMPLE TITLEHOLDER'S NAME (II other than owner): address (if applicable): . DESCRIPTION OF WORK: LIVING AREA: # BEDROOMS ~ g ~ CD ~ . IF MOBILE HOME OR RV: MAKE ~ Q. ~ o Ih W o . WORK CODE: 1t___~ PLANS ON FILE? MODEL NAME: VALUATION: $ )( #/'1>0 / - o NO 0 YES . BONDING COMPANY: ADDRESS: CITY STATE ZIP ~ 0 9 . ARCHITECT/ENGINEER: CD a: ADDRESS: CITY STATE ZIP w i!: . MORTGAGE LENDER: 0 ADDRESS: CITY STATE ZIP PHONE' ( CITY STATE ZIP PASCO CO COMPUTER 101: ~ 9 CD ~ . ELECTRICAL CONTRACTOR: ~ SIGNATURE: ~ ADDRESS: ~ STATE L1C , (if applicable): 8 POWER CO: PHONE # ( CITY STATE ZIP PASCO CO COMPUTER 10.: SAWPOLE: AMPS: . MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE L1C # (if applicable): o NEW OALTERATION VALUATION: $ PHONE # ( CITY STATE PASCO CO COMPUTER 10.: (Required) ZIP . PLUMBING CONTRACTOR: SIGNATURE: ADDRESS: CITY STATE L1C # (if applicable): # FIXTURES: - SEPTIC PER ,: PHONE # ( STATE ZIP PASCO CO COMPUTER 10.: SEWER: WATER: PLUMBING FEE: $ WELL: . OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE L1C # (if applicable): TYPE CONTRACTOR: CITY PHONE # ( ) STATE ZIP PASCO CO COMPUTER 10.: VALUATION: $ JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT" (permit form 10/91) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF. PC93043032 . . .. NOTiCE".." BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION