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PASCO COUNTY BUILDING PERMIT APPLICATION CENTRAL PERMITTING OFFICES: SHADED AREAS FOR OFFICE USE ONLY · 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 MONTHS --------------------------------------------------------------------------------------------------------.- IS THIS APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOlATION? Y _ N l:l OWNER'SNAM~<"'~~~ PHONE. (.l2'L::L) ~~ -.'7f'r6'1 9 JOB LOCATION: _ 9. CJ __ __ e _---!- SUBDIVISION: r;u;;:; ~_ _ m PARCEL 10#: S . T ~ R SU BLK J2a!q,OT ~~PROJECT' TAl _ LOT SIZE _X_ i OWNER'S PRESENT ADDRESS: </90 q ('I'J 'nAt.J,G 3T: CITY: Z~IJ#,VR II/~ STATE: Fe... Z1P~.3 S-q / o FEE SIMPLE TITLEHOLDER'S NAME (rt other than owner): VA address (rt applicable): CITY: STATE: ZIP: ~~~~~~~ -~~;;~~:- R~ p,,-;:: - -;;;;~~ - :~~ ~-; -;;;/1 ~ y;U-;-;;' -;;;; ~ -;;; - -- - - - - - - - -- - -- - - - - -- - --- -- --- --. ~ UVING AREA: PATIO: GARAGE: . ENTRY: TOTAL UNDER ROOF: B&.::l L c:;- 9 , BEDROOMS - , BATHROOMS -- _ lYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: m Fill Y _N_ ~ IF MOBILE HOME OR RV-~E YEAR SIZE ~ WORK cooeOe(,-- PLANS ON FILE? 0 NO 0 YES PRE-PAID PLANS FEES: $ ffi f' MODEL NAME C ' VALUATION $ ~ --------------------------------------------------------------------------------- BONDING COMPANY: /IIa. ~ ADDRESS: o ~ ARCHITECTIENGINEER: ;C;Qet'J c:. ..Jt1)~6S , I?~ a: ADDRESS: t.//~f3 //;l7A r;r. {7; CITY: E. E'LLe-""'-"eJ/\.- STATE:.a ZIP: 1~!l.2-:2 w S MORTGAGE LENDER: ,,/ A ADDRESS: CITY: STATE: _ ZIP: ------------------~--------------;r-----------~---------------------------------- COtmW:fOrt tJrit:r~a-vv'~"NcE ~~~. LK' , SIGNATURE: PHONE' ( ~ ) .6:L.S.. - I Boo ~ ADDRESS: 10' . ~ ? 7 CITY: Z 4-,12 ~ 0 STATE: .EL ZIP: ~ 577 ') 8 STATE UC, (rt applicable) t: ec tJ493 67 PASCO CO COMPUTER IOf: ""75"'j{ 7 ...J m g ELECTRICAL CONTRACTOR: o SIGNATURE: ~ ADDRESS: ~ STATE UC , Qf applicable) o POWER CO: CllY: STATE: _ ZIP: PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 101: SAWPOLE: AMPS: MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE UC , Qf applicable) o NEW 0 ALTERATION VALUATION: $ PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 101: (Required) PLUMBING CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # Qf applicable) # FIXTURES: SEPTIC PER , PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 101: SEWER: WATER: WEll: OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC , Qf applicable) lYPE CONTRACTOR: PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE lYPE: AMOUNT: $ RECEIPT': --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO TOTAL BUILDING PERMI RECORD AND POST A "NOTICE OF COMMENCEMENT' AIM' ". $ c.jI , """prcve~ . ....NOTlCE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION (pennit fOllTll0191) EDITIONS OF THIS FORM RELEASED BEFORE 1191 ARE OBSOlETE AND W1Ur NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC930430321G . (OVER)