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. CENTRAL PERMITTING O~:~~~:COUNTY BUI~D=....PER"'~............... p........p........L...~.li~~~OR OFFICE USE ON~Y · Dade City: (352) 521-5144 FAX (352) 521-5149 eyv'1 ..... 13852 17th St., Dade City . '.- · New Port Richey: (727) 847-8126 FAX (727) 847-8901 7530 Utlle 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 RE ULT ,~TOP WORK ORDER OR NOTICE OF VIOLATION? Y _ N_ ~ OWNER'S NAME: / V PHONE. (&"/3) 7$}.-r _ 'L.-~ <f 9 9 JOB LOCATION:. ":?J?' S- "'1 r --L. 2- V ~ SUBDIVISION: -z:~ 12- h / 1--/ ~ ~ PARCEL 10#: S tI-- T ~ R.3::.L suB02tt2 BLI0.t.laO LOT t)t>//) PROJECT * TAl _ LOT SIZE _X_ ~ OWNER'S PRESENT ADDRESS: CITY: STATE: ZIP: ~ FEE SIMPLE TITLEHOLDER'S NAME (if other than owner): address Of applicable): CITY: STATE: ZIP: ~ ~~~=-~;;;;~-=r;~;.~~E7~-;:,rt:;,~-;,~7---~i;;iZ;;;--~~~-==F-~-~:=-0- 9 . BEDROOMS - . BATHROOMS _- _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: a:l FILL Y _N_ ~ IF MOBILE HOME OR RV: MAKE YEAR SIZE J= Q. a: WORK CODE PLANS ON FILE? 0 NO 0 YES PRE-PAID PLANS FEES: $ ffi MODEL NAME c VALUATION $)-, .~=3 9 s-: 0 c., RECEIPT': --------------------------------------------------------------------------------- BONDING COMPANY: ~ ADDRESS: u o ffi ARCHITECT/ENGINEER: ffi ADDRESS: i= o MORTGAGE LENDER: ADDRESS: CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: CONTRACTO. ... SIGNATURE' ~ ADDRESS: . [ I g STATE UC . Of applicable) ...J a:l e ELECTRICAL CONTRACTOR: ~ SIGNATURE: .... ADDRESS: ~ STATE UC . (if applicable) U POWER CO: PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: SAWPOLE: AMPS: MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . (if applicable) o NEW 0 ALTERATION VALUATION: $ PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: (Required) PLUMBING CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . Of applicable) . FIXTURES: SEPTIC PER. PHONE' (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: SEWER: WATER: WEll OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . Of applicable) TYPE CONTRACTOR: PHONE. (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: $ RECEIPT.: --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENr ....NOTlCE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE sloe Of THIS APPUCATION (pennil form 10191) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC930430321G (OVER)