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<br />rn ':L - :;;L Co ; ~ l - CD I D - (jJJlJ(j - 0 4::.LQ <br />. 'f,ASCO COUNTY BUILDING PERMIT APPUCA nON <br />SHADED AREAS FOR OFFICE USE ONLY <br /> <br />CENTRAL PERMITTING OFFICES: <br /> <br /> <br />. Dade City: (904) 521-4206 <br />37918 Meridian Ave., Rm 234, Dade City <br />. New Port Richey: (813) 847-8126 <br />7530 Little Rd., Rm. 210, New Port Richey <br />. Land O'Lakes: (813) 929-1266 <br />4111 Land O'Lakes Blvd, (US 41), Land O'Lakes <br /> <br /> <br />THIS APPLICATION MUST BE TYPED OR PRINTED IN INK <br />AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS <br />ISrnIS~PUCilIONT~~S~TOFASTOPW~O~~ORNOTIC~FVIOUTION?Y--N--- <br />. OWNER'S NAME: {l'CJSI=lN'O tJ P ;. ~n~ J>c: V r 0 tJ ~ 1-:>0 I" 1 PHONE' ( ) "} 8.3 - I ~ :1":::-- <br />JOB LOCATION: '3t ](.,.f V vt..c:.. /l.u <..R SUBDIVI~I()~; VI&.i-ff9e-~i?cV' . <br />PARCEL ID'; S _ T _ R _ SUB BLK LOTPROJECT,<TAZ:: LOT SIZE X <br />OWNER'S PRESENT ADDRESS:~ 'X I" ( V U L. ell,.., C It CITY: z..;-? i-i"l R H/I..L.<.. _STATE: ~'-~ iiP33.],~~ <br /> <br />. FEE SIMPLE TITLEHOLDER'S NAME (II other than owner): <br />address (il applicable): <br /> <br />. DESCRIPTION OF WOR . <br />8 LIVING AREA: <br />..J # BEDROOMS <br />CD FILL Y_ N_ <br />z <br />o . IF MOBILE HOME OR RV: MAKE <br />~ <br />0- <br />a: <br />() <br />(/l <br />w <br />o <br /> <br /> <br />CITY <br /> <br />STATE <br /> <br />ZIP <br /> <br />--?Ob~~Ve~------------------------ <br /> <br />TIO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br />, BATHROOMS; _ _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br /> <br />. WORK CODEilii!ii:~~t\1I~1\w <br /> <br />PLANS ON FILE? 0 NO 0 YES <br />MODEL NAME: <br /> <br /> <br />LtSEi"'?ry <br /> <br />YEAR <br /> <br /><:17 <br /> <br />SIZE /'1 j. t.,. c <br /> <br /> <br />VAL 0: $ .~,., eO <br /><<?l~ <br />------------~------------- <br />-----.-- <br /> <br />:ll:: CITY STATE ZIP <br />() <br />9 . ARCHITECT/ENGINEER: <br />CD <br />a: ADDRESS: CITY STATE ZIP <br />w <br />J: <br />~ . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />~O~NRACTO . ~~------------------ <br /> <br />SIGNAT :,~,' . r, ",:~~1" PHONE#( )7J'~ -15-P/) <br />~ ADD SS:_ _,; CITY STATE ZIP <br />^ .....-.. _..~ .. ... .. <br /> <br />S381dX3 <br />NOISSI~~O::> ^~ <br /> <br />S3tlldX3 <br />NOISSIv-lv-lO::> Av-l <br /> <br />IN3D'v' tlO tl3NMO <br />01. S'v' AtI'v'10N <br /> <br />tlO1.Q'v'HlNOQ <br />01 SV AtlVl'! <br /> <br />31'10 <br />I <br />,-I ,-, <br />, ~ ' 3D'v' l:S tl3NMO <br />3ttl1.'v'NDIS~~7?~ YCn ,_ ~tln1.VN8IS <br />/, ill' y~ / ^'- <br />'lN3W3QN3WWOO ::I~'3QII0N tlnOA 8NIOtl6Q3t13t10::l38 A3NtlOllV NV tlO tl30N31 <br />tlnOA H.lIM .llnSNOQ '8NIQNVNI::I NIV 18001 ON31NI nOA ::II . A.ltl3dOtld tlnOA 01 SlN3v-l3^OtldWI tlo::! 3QIMl. <br />8NIA'v'd tlnOA NI .llnS3tl AVW .lN3W3QN3WWOQ ::10 3QI.lON 'v' OtlOQ3tl 01 3tln1I'v'::! tlnOA :tl3NMO 01 DNINtI'v'M <br /> <br />/6 - <br /> <br />eL/ -'el/' //~vo <br /> <br />tl01QVtl1.NOQ <br />