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.' PASCO COUNTY BUILDING PERMIT APPLICATION CENTRAL PERMITTING OFFICES: SHADED AREAS FOR OFFICE USE ONLY · Dade City: (352) 521-5144 fl\l.. (352) 521-5149 13852 17th St., Dade City · New Port Richey: (727) 847-8126 FI\I.. (727) 847-8901 7530 Uttle Rd., Rm. 210 New Port Richey · Land O'Lakes: (813) 929-1266 FI\I.. (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_ ~ OWNER'S NAME: "6e'ljcxrviln -t 0'30. Kodr"3utz- PHONE# (_) 9 JOB LOCATION: 3QLY5 rYleClc\owood Loop Zeph~,..h,jls SUBDIVISION: lYl("rl(\ol,)()()c! C:sta-\-e'S. ~ PARCEL 10#: S ~ T ~ R -1L. SUB ~ BLK ~ LOT 038V PROJECT' .' TAl _ LOT SIZE _X_ ~ OWNER'S PRESENT ADDRESS: 3o,&,-/r:; meodowood Loo'p CITY: -Zeph~r h, II S STATE: F I ZIP::;; 35'-1 0 3: o FEE SIMPLE TITLEHOLDER'S NAME Qf other than owner): address Qf applicable): CITY: STATE: ZIP: ---------------------------------------------------------------------------------------------------------- DESCRIPTION OF WORK: KErn 0 j) E L ~ UVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: 9 # BEDROOMS - # BATHROOMS -- _ lYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: m FILL Y _N_ ~ IF MOBILE HOME OR RV: MAKE 10 1 A YEAR tJ I A SIZE -J I A 1= Q. ~ WORK CODE ti\.rz.R o . VALUATION $ J 0 . 5" ~ ( . --------------------------------------------------------------------------------- BONDING COMPANY: ~ ADDRESS: o o ar ARCHITECTIENGINEER: ffi ADDRESS: ~ o MORTGAGE LENDER: ADDRESS: PLANS ON FILE? 0 NO 0 YES MODEL NAME PRE-PAID PLANS FEES: $ RECEIPT It: ~S e.- ~ C CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: --------------------------------------------------------------------------------- CONTRACT . tt on c- . SIGNATURE: 2"'PHONE It ( :3::;:;),,) '/ q '7 - S 5 SL> ~ ADDRESS: son St CITY: 6rool-<sv,lle STATE: EL ZIP: 3<1&01 g STATE UC # Qf applicable) C G - co;)!;J 9 '-13 PASCO CO COMPUTER 10It: ...J m a: ~ ELECTRICALC ELECTf<.ICiJL SERVICE }JC. o SIGNATURE: PHONE' (.:::J21) '1? u 3- 0605 ~ ADDRESS' '-/ fl 0 AVE CITY: HUJ)soAJ STATE: F"'L ..lIP: 3'-1&;1/1 ~ STATE U # (if applicable) ~ C 000 ;;J ~ & 5' PASCO CO COMPUTER 101: / ;J 'f 6....'/ o POWER CO: SAWPOLE: AMPS: /~, '8 'i :J # (if applicable) (-Ij c.. 0 ~;r/3 5 '7 o ALTERATION VALUATION: $ E # (1~1) '6"4 I -1150 CITY: Sf R IN {; 1-11 L L STATE:....E..!::.... ZIP: .31& II PASCO CO COMPUTER 10M: 3 '6 ~ "3 (Required) PLUMBING C TOR: C- J.../ (-l RLI ES SIGNATUR . ADDRESS: Q J LV, JO"Ef<SoJJ ST STATE UC # Qf applicable) CF-C aS? '-/ IPB # FIXTURES: SEPTIC PER # PLurnl3l1JG PHONE' ( 35 ~ ) 75 '1- ?tJoo CITY: ?'RoIJKS y 11.-1-- ESTATE: L.!::... ZIP: ..34&0 I PASCO CO COMPUTER 101: SEWER: WATER: WELL: OTHERCONTRACJeJl:. ~IlJ~ .Il...lc. SIGNATURE: ~-, ..' PHONE# (35J ) 75'-1- 'jf8"f?O ADDRESS: 3.;1 q -uJ Je mr50 n Sf. CITY: "?'r-o{Jk<.v 1 lie STATE:....E:L ZI~: 3</u1JJ STATE UC # Qf applicable) (' C C 0 '-Il.J 1'1:) PASCO CO COMPUTER 10It: -:) ;; Of:; TYPE CONTRACTOR: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE lYPE: AMOUNT: $ RECEIPT#: --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENl" TOTAL BUILDING ....NOTICE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPUCATION (peImit l0Il1110191) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOlffi AND W1U NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC930430321G (OVER)