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<br /> <br /> <br />CENTRAL PERMIITING OFFICES: <br /> <br /> <br />. Dade Cily: (904) 521-4206 <br />37918 Meridian Ave., Rm 234, Dade City <br />. New PorI Richey: (813) 847-8126 <br />7432 Little'Road, New PorI 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 PERMJITED ~ITHIN 6 ~NTHS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ <br />------ <br /> <br />~ffi~~~~ TJ~~a~Q&.OTD'l/OPRJf~~t~~~_j~LO~~g:~:~ <br />'~ OWNER'S ESENT ADDRESS: .51'\ t1I\E CITY: 2- H ~ \ l~ STATE: F'L ZIP <br />~ <br />o <br /> <br />. FEE SI PLE TITLEHOLDER'S NAME (It olher than owner): <br />addr (II applicable): <br /> <br />CITY <br /> <br />STATE <br /> <br />ZIP' ' <br /> <br />~~RI~~;WO~----~~nc~~-S~~M~9-~DL------------- <br />~ LIVING ARE.A PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br />~ , BEDROOM, "BATHROOMS:__ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: <br />to FILL Y_ <br />z <br />o . IF MOBILE t ME OR RV: MAKE <br />1= <br />Q. <br />0: <br />o <br />en <br />w <br />c <br /> <br /> <br />YEAR <br /> <br />SIZE <br /> <br />~::~~:::':::::::::'::?:::::::::'::::::~:~~:::~ <br />. WORK CODE: kWl'%hWih] PLANS ON FILE? 0 NO 0 YES <br />MODEL NAME: <br /> <br />VALUATION: $ <br /> <br />15,DOO'C:>O <br /> <br /> . BONDING COMPANY: <br />~ ADDRESS: CITY STATE ZIP <br />0 <br />0 . ARCHITECT/ENGINEER: <br />...J <br />to <br />a:: ' ADDRESS: CITY STATE ZIP <br />w <br />i= . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />. CONTRACTOR:_6!ffl-ne <br />SIGNATURE: <br /> <br /> <br />~ <br />o <br />9 STATE L1C # (it applicable): <br />to <br />15 . ELECTRICAL CONTR <br />t; SIGNATURE: <br />~ ADDRESS' <br />!Z S~ATE L1C "(i' appli <br />8 POWER CO: <br /> <br />." : MEPHANICAL CONTR~CTOR: <br />, SIGNATURE:' " <br />ADDRESS: <br />,STATE L1C # <il applicable): <br />o NEW 0 ALTERATION VALUATION: $ <br /> <br />PHONE # < <br />CITY STATE <br />PASCO CO COMPUTER 10M: <br />(Required) <br /> <br />ZIP <br /> <br />. PLUMBING CONTR~CTOR: S r!fJne 8ftt/8I15/Sml/6f15 PctLS TII6- tnd Geo~r(7.- fr't11::' LUMBiNG <br />SIGNAT.URE: ' . . PHONE # ( ff/3) 90/''1 - ~21;!..: FEE: < <br />ADDRESS: fl734 L-O-L-I3Iu:! CITY li2ncl {) ~ STATE PI ZIP gtfc,3Q <br />STATE UC # (iI applicable): ~~OO(P 0 \88 PASCO CO COMPUTE!l-IDN: f..p5fo-z.. <br /># FIXTURES: - SEPTIC PER 1#: SEWER: V ' WATER: /' WELL: <br /> <br />. OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C 1# (il applicable): <br />TYPE CONTRACTOR: <br /> <br /> <br />PHONE # ( ) <br />CITY STATE ZIP <br />PASCO CO COMPUTER 101: <br />VALUATION: $ <br /> <br />---------------------.---------~--~~~. <br /> <br />OTHER FEE TYPE: <br /> <br />. . .. .. . <br />:-:...:.....:-::.:.:.:;..:;:>.:... .... <br /> <br />---------------------------------- <br /> <br />JOBS UNDER $2,500 IN VALUE DO NOT NEED TO <br />RECORD AND POST A "NOTICE OF COMMENCEMENT" <br /> <br />. .. .. <br />. . .. .' . <br />. TOTAL BUILDING PERMIT FEE: <br /> <br />$ <br /> <br />" " "" NOTICE..'.. <br />BOTH THE OWNER AND CONTRACTOR OF RECORD (License Holder) MUST READ AND <br />(permillorm 10/91) SIGN THE REVERSE SIDE OF THIS APPLICATION <br /> <br />EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERM/ITING STAFF <br /> <br />/' <br />