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PASCO COUNTY BUILDING PERMIT APPLICATION CENTRAL PERIVIiTTING OFFICES: SHADED AREAS FOR OFFICE USE ONLY . Dade City: (352) 521-51~ FP\X (352) 521-5149 SEQ#' . //'1o,IJ~ 13852 17th St., Dade City . ,tf-r7 d . New Port Richey: (727) 847-8126 'FP\X IJ27'J 847-8901 7530 Uttle Rd., Rm. 210 New Port Richey . Land O'Lakes: (813) 929-1266 Fp\x (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 PERMITfED WITHIN 6 MONlHS ---------------------------------------------------------------------------------------------------------. IS THIS APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? Y - N_ G OWNER'S NAME:"'B od r \~e -z. ~ ~'o rV-\\ ~ '\- 0 \ 3~ PHONE - (-) g JOB LOCATION: 391,L\5. ~O~() () Loo - Ie plclir IISUBDIVISION: CD PARCEL ID#: S ~ T.-a6... R ~ SUB Q1!iQ BLK OO<:'C c LO ~ PROJECT' TAl - LOT SIZE _X_ ~ OWNER'S PRESENT ADDRESS: 3'1LPYS \'Yl{"cH:\oL0ood Lnop CITY: Lef~r-h\I\S STATE: ~\ ZIP: ~ FEE SIMPLE TITLEHOLDER'S NAME (if other than owner): address (if applicable): . CITY: STATE: ZIP: -~E~~~~;;;~-~;~~;~:-~-~;~~~------------------------------------------------------------------------. o LIVING AREA: PATIO: GARAGE: ENTRY: TOTAl UNDER ROOF: g # BEDROOMS _ # BATHROOMS _- _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: CD FILL Y _N_ I 5 Jr MOBILE HOME OR RV: MAKE D I A YEAR U A SIZE kJ I A f= a. a: WORK CODE /, "'\ c> PLANS ON FILE? 0 NO 0 YES ~ ~ r~ \\ MODEL NAME o ~~~~~'~~_ ~_ _ _-'-~~~!nm _ _m___ n_ __m m _m__~~C_E~~!nm__ mn nm_ m__~. $; B 0 . <9 iJ BONDING COMPANY: x: ADDRESS: u o a:l ARCHITECT/ENGINEER: ex: ADDRESS: u.J :x: ..... o MORTGAGE LENDER: ADDRESS: PRE-PAID PLANS FEES: $ CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: ----------------.----------------------------------------------------------------- CITY: STATE: _ ZIP: CONTRACTOR: l=ic:\co Cons -\-(1 H' ~nrl . lllc, SIGNATURE: . . PHONE. ( 35 a) 'I q '7 - 5 5S 0 y- ADDRESS: 3;;2q 1..1.). .jE'~Rrson St CITY: br-ooKSl(llk: STATE:.EL ZIP: 3'-1 GO I g STATE L1C # (if applicable) CG - co;J ;J ,} '-/ 3 PASCO CO COMPUTER 10_: IOLi33 ..J CD ~ ELECTRICAL CONTRACTOR: U oR E J.-;':; C TR Ie R L -5 E f( V Ie E) } A-IC U SIGNATURE: PHONe. (:JZL) ?& 3- oooS g ADDRESS: /;).'"-/I'-J CI-/lCfIGD AVE CITY: 14uDSOIJ STATE: E- ZIP: 31/;LP9 ~ STATE L1C # (if applicable) E C 00 0 ? 8" &>:5 PASCO CO COMPUTER 10': I <l "6'1 U POWER CO: SAWPOLE: AMPS: '..". :.~.:.::~ ELECTRICAL FEE: '$ MECHANICAL CONTRACTOR: R c }J ~ SIGNATURE: ADDRESS: PO. Bo x 5 ~ '-/::; STATE L1C # (if applicable) ell C 0 :1"7 "3 s: o NEW 0 ALTERATION ATION: $ MECHANICAL 3"11.P II PJ..urn{3j1.JG PHONE_ (35.:2 ) 75'1- 8'-(06 CITY: ?1rooksvdk STATE: ..E1:... ZIP: 3'-/(pol PASCO CO COMPUTER 10': 0' 1'1 Lj , S8NER: WATER: WEll: PLUMBING - FEE: $ PL NG CONTRACTOR: C. 1-1 A R. I- I ES SIGN.AJURE: ADDRESS: ~lQ I LJ. Jeffirson St STATE L1C # (if applicable) C p- CO 5'7 '-I/,; 8 # FIXTURES: SEPllC PER - OTHER CONTRACTOR: Pllan's Koo~/;JG. \r..Jc. SIGNATURE: PHONE' (~) 507-5550 ADDRESS: :~.QCj Lv. ,Jeffirson -Sf: . CITY: J2,r()okSVII Je STATE: ..EL ZIP: 3t-/t;(j1 STATE L1C # (if applicable) Cc c 0'1 u qA/,Q PASCO CO COMPUTER 10_: TYPE CONTRACTOR: !<. 0 0 (- E R VAlUATION: $ FEE: $ c32. 06 --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: $ RECEIPU: RADON FEE: $ $~() --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VAlUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT' TOTAL BUILDING PERMIT FEE: . . · · NOTICE · · · · BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION (peonit lorm 10/91) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLm AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC930430321G (OVER)