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<br />CENTRAL PERMITTING OFFICES:
<br />
<br />
<br />. Dade City (904) 521-4206 -
<br />. 37918 Meridian 'we.. Rm 23<1, Dade City /'
<br />. New POit Richey: (813) 8<17-8126 -?-_
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<br />. ~~~~ ~'~~:e~' R7B1231109~~~2~~rt Riche -- . .... ......]~j:~~<.,.,.. .
<br />~;~ I;;~~~;;;~~~~;:;;~~~ INK _ _ _ ,iN:i.MJ&;%TI.L==_=r~~!~~l..
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<br />is THIS-APPLICATION THE RESULT OF~-STOP WORK ORDER OR NOTICE OF VIOLATION? Y_ N_
<br />~ .0WNEn'sNAME: m,'KE O;rYl/-r~ I PHONE'( ). . "." .... ,.,
<br />_ JOB LOCATION: .5 9' to S' I /~1l11 0 I{ I V~ Si I>>S'!~~~"!~!?~:...... ....,....:. E' ~ . .
<br />;;; PARCElID":S~ T :7S' R~SUBPOI I:) BLK 1/. DOLOT bOO "ROJEeT'::i:::::::'::::"::.:::::i{::':::::::::~:!<fg~::::::!:::::"::'HlOT~IZ _X_
<br />~ OWNER'S PRESENT ADDRESS: CITY: STA~: tip
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<br />. FEE SIMPLE TITLEHOLDER'S NAME (II other \h811 owner): -
<br />lIddrM!; (II applicable): CITY . STATE ZIP ..
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<br />-------------------~~~~~-~-~~~'~.
<br />
<br />~ESCR'PTION OF WORK: - 7! E' j(,b" ~
<br />~ LIVING AREA: PATIO: GARAGE: ENTRY: TOtAL UNDER ROOF:
<br />g , BEDRooMS , BATHROOMS: _'_ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER:
<br />.J -
<br />co FILL Y_ N_
<br />~ . IF MOBILE HOME OR RV: MAKE
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<br />. BONDING COMPANY:
<br />ADDRESS:
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<br />CITY
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<br />STATE
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<br />ZIP
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<br />~Ir~
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<br />.....,..
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<br />YEAR
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<br />SIZE
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<br />. WOnK CODE~*~*1t1m~'I PLANS ON FILE? 0 NO 0 YES
<br />MODEL NAME
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<br />.... ..'.......-'...... ,....,. ','" '.' ."..,"
<br />...."~~~~I6~LA~S FEES~rS ....: :...:::):.C,;:::;
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<br />VALUATION $ S 6CJo. 0 (;)
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<br />9 . ARCHITECTfENGINEER:
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<br />a: ADDRESS:
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<br />CITY
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<br />STATE
<br />
<br />ZIP
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<br />. MORTGAGE LENDER:
<br />ADDRESS:
<br />
<br />CITY
<br />
<br />STATE_ZIP
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<br />. CONTRACTOR: _.il:.~..LU)..~ A.~ ~ F/d t
<br />SIGNATURE: ~~_ PHONE' (
<br />ADDRESS: - CITY STATE
<br />STATE lIC . (il applicable): PASCO CO COMPUTER 101:
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<br />~ . ELECTRICAL CONTRACTOR:
<br />t> SIGNATURE:
<br />: ADDRESS:
<br />~ STATE lIC . (II applicable):
<br />8 POWER CO:
<br />
<br />ZIP
<br />;l,s- ~
<br />
<br />. . .... .',..::.
<br />
<br />PHONE' (
<br />CITY STATE
<br />PASCO CO COMPUTER ID,:
<br />SAWPOlE:
<br />
<br />ZIP
<br />
<br />AMPS:
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<br />
<br />. MECHANICAL CONTRACTOR:
<br />SIGNATURE:
<br />ADDRESS:
<br />STATE L1C , (II applicable):
<br />o NEW 0 ALTERATION VALUATION: S
<br />
<br />PHONE' (
<br />CITY STATE
<br />PASCO CO COMPUTER ID':
<br />(Required)
<br />
<br />ZIP
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<br />PHONE. (
<br />STATE
<br />PASCO CO COMPUTER ID':
<br />SEWER:
<br />
<br />: PLUMBiNG'
<br />FEE: S
<br />
<br />. PLUMBING CONTRACTOR:
<br />SIGNATURE:
<br />ADDRESS:
<br />STATE L1C "(11 applicable):
<br />, FIXTURES:
<br />
<br />CITY
<br />
<br />ZIP
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<br />- SEPTIC PER .:
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<br />WATER:
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<br />WELL:_..
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<br />. OTHER CONTRACTOR: OTHER
<br />SIGNATURE: PHONE' ( ) ,BlDG.:,::
<br />ADDRESS CITY STATE ZIP :FEE::'$
<br />STATE lIC "(11 applicable): PASCO CO COMPUTER ID': . ... .......,..,,,....,'.:',.,::...
<br />TYPE CONTRACTOR: VALUATION: $ ..... '.' \.:y.::i.;l.,l.:;:n:m\:'::?-::::,.':"':'., ..
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<br />OTHER FEE TYPE:
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<br />A~UNT: S
<br />
<br />
<br />. . RECelPTf:. .
<br />
<br />RADON.' ,....\::::.\.:.:::: ::':" . ...
<br />FEE:. :..$
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<br />
<br />JOBS UNDER $2,500 IN VALUE DO NOT NEED TO
<br />RECORD AND POST A "NOTICE OF COMMENCEMENT"
<br />
<br />TOTAL BUILDING PERMIT FEE:
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<br />.
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<br />. . .. NOTiCE....
<br />BOTH THE OWNER AND CONTRACTOR OF RECORD (license Holder) MUST READ AND
<br />SIGN THE REVERSE SIDE OF THIS APPLICATION
<br />
<br />(permit farm 10/91)
<br />EDITIONS OF THIS FORM RELEASED BEFORE 1191 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMlmNG STAFF
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<br />PC930430321C
<br />
<br />(OVER) .
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