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<br />CENTRAL PERMITTING OFRCES: <br /> <br />PASCO COUNTY BUILDING PERMIT APPUCA nON <br />. SHADED AREAS FOR OFFICE USE ONLY <br /> <br />. Dade City: (352) 521-5144 <br />13852 17th St, Dade City <br /> <br />. New Port Richey: (813) 847-8126 <br />7530 UttJe Rd., Rm. 210 New Port Richey <br /> <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 />IS~IS~PLIC~IONrnE~S~OFASTOP~~O~~ORNOTICEOF~OUTION?Y--N--- <br /> <br />~F:."*R!';;E"Jlf~~-;f!?;~:x Q1.~LOT C';4fR~~i~~:'bH~:::;~~ <br /> <br />~ OWNER'S PRESENT ADDRESS: q- ~ ~rt,.I/f(./-.1E: CITY: "2!: JlI'A 1(' STATE-FJ.' ~- <br />~ Z"- '7 n C't') t <br />. FEE SIMPLE TITLEHOLDER'S NAME (II olher than owner): - <br />address (if applicable): CITY <br /> <br />STATE <br /> <br />ZIP <br /> <br />~~RIP~N~WORK:-~~~~e~-~~;D-----------~---------- <br />~ UVING AREA: PATIO: GAAAGE: ENTRY: TOTAL UNDER ROOF: <br />~ , BEDROOMS # BATHROOMS: ~ _ TYPE CONSmUCTION: 0 BLOCK . FRAME 0 OTHER: <br />CD .FILLY_N_ f I <br />5 . IF MOBILE HOME OR RV: MAKE IV/} :3/7?(11- YEAR /'71 SIZE /..t X StiJ <br />1= <br />D- <br />o: <br />() <br />rn <br />w <br />o <br /> <br /> <br />. WORK CODE: .&'1\1 PLANS ON FILE? 0 NO 0 YES <br />MODEL NAME: <br /> <br />VALUATION: $ /5~, ~ <br /> <br />':': :">.: :.;';.:::::':..':::}':'}:::::::;::;:;::::;;::::';(~:~ <br /> <br />....., <br />,.,......... <br /> <br />--------------------------------- <br /> <br /> . BONDING COMPANY: <br />~ ADDRESS: CITY STATE ZIP <br />() <br />0 . ARCHITECT/ENGINEER: <br />-' <br />CD <br />a: ADDRESS: CITY STATE ZIP <br />w <br />J: <br />f- . MORTGAGE LENDER: <br />0 <br /> ADDRESS: CITY STATE ZIP <br /> <br />--------------------------------- <br /> <br />. CONTRACTOR: . CHARLES L. SOBEL 7cf"2--~P,4 - <br />SIGNATURE: "("~ c.....J:1. ~. ~...v~ PHONE' ( 954 ) 783-1886 <br />~ ADDRESS:303 S.E. 6th Ave CITY Pompano Beach STATE Fl. ZIP 11060 <br />9 STATE L1C, (if applicable): CG-Co45439 PASCO CO COMPUTER 101: 10222 <br />CD <br />a: <br />o <br />f- <br />() <br />< <br />a: <br />f- <br />z <br />o <br />() <br /> <br />. ELECTRICAL CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (il applicable): <br />POWER CO: <br /> <br />PHONE # ( <br />CITY STATE <br />PASCO CO COMPUTER 10#: <br />SAWPOLE: <br /> <br />ZIP <br /> <br />AMPS; <br /> <br />. MECHANICAL CONTRACTOR: <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 ID#: <br />(Required) <br /> <br />ZIP <br /> <br />. PLUMBING CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: CITY <br />STATE UC # (il applicable): <br />, FIXTURES: - SEPTIC PER #: <br /> <br />PHONE' ( <br />STATE ZIP <br />PASCO CO COMPUTER 10#: <br />SEWER: WATER: <br /> <br />WELL: <br /> <br />CITY <br /> <br />PHONE' ( ) <br />STATE ZIP <br />PASCO CO COMPUTER ID#: <br />VALUATION: $ <br /> <br /> <br />. OTHER CONTRACTOR: <br />SIGNATURE: <br />ADDRESS: <br />STATE L1C # (il applicable): <br />TYPE CONTRACTOR: <br /> <br />~THE'::EE TYPE: _ _ _ __ _~_A~U~rS ...:::;~.;:::'~ R~c:EI:#~ _ _~ ~'~ _ _ ~;~N. <br />JOBS UNDER $2.500 IN VALUE DO NOT NEED TO <br />RECORD AND POST A .NOTICE OF COMMENCEMENr <br /> <br />TOTAL BUILDING PERMIT FEE: <br /> <br />$ <br /> <br />(,:erml~~9n . <br />'~''''''''1Tlr'\l . <br /> <br />. . .. NOTiCE.... <br />BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND <br />SIGN THE REVERSE SIDE OF THIS APPLICATION . <br />