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<br />t-ENTRAL PERMIITING OFFICES: <br /> <br />c ( 1\ 0 F 'Z,e pf-le'ifC H--j //1 <br />. Jsco COUNTY BUILDING PERMIT APPUCA nON <br />SHADED AREAS FOR OFFICE USE ONLY <br /> <br />.. <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK ,. <br />AND IS VOID IF NOT P~~~ ~I!!:!'~ MO~~ _ _ _ _ _ _ _ _ _ _ __~ _ _ _ _ _ _ _ __ __ _ __ <br />------- <br /> <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 a'Lakes: (813) 929.1266 <br />4111 Land a'Lakes Blvd. (US 41), Land a'Lakes <br /> <br />~ ~N:;.:::;;jj i1J/~~ t fi! <i ~ ~&~ Ll::' SUB;,~~'<I~~2 . 'f 8:!J'.2 <br />or PARCELIl'>;S :2.T~R - SUB QJ.UJau< ~ ~T _PR='>'>"""TAtS2tiLOTSIZE~X-=-- <br />W aWNER'SPRESENTADDRESS: SA-fill/!. CITY:.ZEi..IJI"IRiJ rhLl...."TATE: ZIP ~{~J '40 <br />~ f ' <br />o <br /> <br />. FEE SIMPLE TITLEHOLDER'S NAME (if olher than owner): <br />address (if applicable): <br /> <br />CITY <br /> <br />STATE <br /> <br />ZIP <br /> <br />-------------------------------- <br /> <br />~ESC_;PTIO;_OFWORK: -All'" GfJ.h-AJcs:.L 0 ,t r <br />~ LIVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br />~ # BEDROOMS II BATHROOMS: _-_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br />1ZI <br />z <br />o <br />1= <br />a. <br />~ <br />(,) <br />lJ) <br />W <br />Q <br /> <br /> <br />. IF MOBILE HOME OR RV: MAKE <br /> <br />"WORK CODE: ~~ PLANS ON FILE? 0 NO 0 YES <br />MODEL NAME: <br /> <br />YEAR <br /> <br />SIZE <br /> <br />VALUATION: $ <br /> <br />--------------------------------- <br /> <br /> . BONDING COMPANY: <br /> ADDRESS: CITY STATE ZIP <br />~ <br />(,) <br />0 . ARCHITECT/ENGINEER: <br />..J <br />1ZI CITY STATE ZIP <br />It: ADDRESS: <br />W <br />:z: <br />l- . MORTGAGE LEN~FR: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />--------------------------------- <br /> <br />. CONTRACTOR: <br />SIGNATURE: <br />~ ADDRESS: <br />9 STATE L1C # (if applicable): <br />1ZI <br />~ . ELECTRICAL CONTRACTOR: <br />l3 SIGNATURE: <br />~ ADDRESS: <br />!Z STATE L1C II (if applicable): <br />8 POWER CO: <br /> <br />PHONEII ( <br />CITY STATE ZIP <br />PASCO CO COMPUTER I~: <br /> <br />PHONE # ( <br />CITY STATE ZIP <br />PASCO CO COMPUTER ID*: <br />SAWPOLE: AMPS: <br /> <br />. PLUMBING CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (if applicable): <br /># FIXTURES: <br /> <br />. MECHANICAL CON~ACT9R: G-1's q. I"", <'l * of /:tjr -+ U,,~/~ ~ <br />SIGNATURE: . ~ PHONE II ( ) .ft .~ - I ~~ G <br />ADDRESS: . r '.r1.x..CITY "J,j.I.~~ STATE~ZIP ~~ 4b~-"] <br />STATE L1C # (if applicable): } . ~ASCO CO COMPUTER ID*: .5"' 8' ).~'_.- _, """ <br />.? '''9 --':C,' ) <br />a NEW 0 ALTERATIONvc.. ..) -- (Required) <br />,j ~!J.D / <br />~ ~/ <br />PHON # ( )__ __--< <br />ST ~ZIP <br />PASCO CO COMPUTER 10*: <br />SEWER: <br /> <br />CITY <br /> <br />. SEPTIC PER #: <br /> <br />WATER: <br /> <br />WELL: <br /> <br /> <br /> <br />---------------------------------- <br /> <br /> <br />. OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C II (if applicable): <br />TYPE CONTRACTOR: <br /> <br />CITY <br /> <br />PHONE # ( ) <br />STATE ZIP <br />PASCO CO COMPUTER ID*: <br />VALUATION: $ <br /> <br />OTHER FEE TYPE: <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 />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 (License Holder) MUST READ AND <br />SIGN THE REVERSE SIDE OF THIS APPL/CA TION <br /> <br />PC93043032 <br />