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. PASCO COUNTY BUILDING pl!RMrr.APPUCATION ~,z{)1 t- Z={); CENTRAL PERMITTING OFFICES: SHADED AREAS FOR O;~1E ~ · Dade City: (352) 521-5144 FAX (352) 521-5149 13852 17th St., Dade City · New Port Richey: (727) 847-8126 FAX (727) 847-8901 7530 Uttle Rd., Rm. 210 New Port Richey · Land O'Lakes: (813) 929-1266 FAX (813) 929-1307 4111 Land O'Lakes Blvd. (US 41), Land O'Lakes THIS APPLICATION MUST BE TYPED OR PRINTED IN INK AND IS VOID IF NOT PERMITTED WITHIN 6 MONniS --------------------------------------------------------------------------------....----------------------- IS THIS APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? Y _ N 4::::- ~ OWNER'S NAME: ,. A1 /Iy Ir .,,~,,~ PHONE # (_) __ _ 9 JOB LOCATION: S 00., - ..:lo 1".( ~r SUBDIVISION: CD PARCELlD#: s2L... T .3-'- R J.I SUB ClOjO BLK ~LOT'~PROJECT# TAl _ LOT SIZE _X_ ~ OWNER'S PRESENT ADDRESS: ("'60" ... ~ rV" CfI1fCITY:. l~~Y""~ STATE: " ZIP: ;c o FEE SIMPLE TITLEHOLDER'S NAME Of other than owner): address Of applicablef.-= CITY: STATE: ZIP: --------------------------------------------------------------------------------------------------------.- DESCRIPTION OF WORK: ~e."".eI ~ I (;.1I1i",.~ ~ L1VINGAREA: 'OCt ~PATlO: GARAGE: E~: 9 # BEDROOMS -'-- # BATHROOMS ~- _ TYPE CONSTRUCTION: ...aLOCK 0 FRAME CD FILL Y _N_ ~ IF MOBILE HOME OR RV: MAKE YEAR SIZE i= Q., ~ WORK CODE PLANS ON FILE? 0 NO 0 YES PRE-PAID PLANS FEES: $ m MODEL NAME o VALUATION $ ~~ coO RECEIPT #: TOTAL UNDER ROOF: t:.(H) o OTHER: --------------------------------------------------------------------------------- STATE: _ ZIP: BONDING COMPANY: ::.::: ADDRESS: CITY: ~ ARCHITECTIENGINEER: />/W/ ~. ~, Ie/I P. E: ffi ADDRESS: /:1/0 ~r4c., /JrJ~~ ~r:J CITY: bJN4tII"", ~ o MORTGAGE LENDER: ADDRESS: CITY: STATE: _ ZIP: --------------------------------------------------------------------------------- CONTRACTOR- ~~ ~~~ 0 J,,;, / /J "~ol ,;'c ~ ifL:.uehQ:U ';:~n::_. SIGNATURE: .~~ ~. A'_ ~ PHONE # (~) #lJ~/~#~// ::.::: ADDRESS: fIOUI N dlth. ,.,,f46,y CITY: ~*...jj~ STATE: .LJ::... ZIP: g STATEUC#Ofapplicable)~A'- Ob"S-~ PASCO CO COMPUTER 101: Oil f-.?~ ~ G (, t:G/r'/c Co"Z-: ;;9f!.,;p ~ ELECTRICAL C -=_. . o SIGNATURE: PHONE# (Z!aL) IJ"jj- ora's- ~ ADDRESS: ~" ~'o (;..1 CITY: ~.r.uss.. STATE: 1''- ZIP: J l.f"'" a.. ~ STATE UC # (if applicable) ~ , :'7 PASCO CO COMPUTER 10#: 00 S.;a., " <J POWER CO: SAWI'OlE: ::ld),tI-i€/~ .. Pt STATE: i!J... ZIP: Zvt:"Jv MECHANICAL SIGNATURE: ADDRESS: STATE UC # (if applicable) (I J..1flo2C1 ~/~ o NEW 0 ALTERATION VALUATION: $ (Required) C I L ( () ( L' / tl/t=,ElX 7lJ RI:&~ PLUMBING C : . ""- ~ (.. ~ ~ W' li\)'V'\ J? l V) ~ l! ~ . ' SIGNATURE: PHONE # ( ~ I J ) U '7 ~ 6 .~ 7 S")~6 . ADDRESS:? " 1 1/ ( CITY: t- crt...... STATE: & ZIP: lV'1: }~9 STATE UC # Of applicable) (' l:v '11" '1' PASCO CO COMPUTER 101: S'78' -z..... # FIXTURES: SEPTIC PER # SEWER: WATER: WELL: OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # Of applicable) TYPE CONTRACTOR: PHONE# (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 101: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: $ RECEIPT#: --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENr TOTAL BUILDING ....NOTlCE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPUCATION (pem1ilIOllll 10/91) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLffi AND Will NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC930430321G (OVER)