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<br />PASCO COUNTY BUILDING PERMIT APPLICATION
<br />CENTRAL PERMITTING OFFICES: SHADED AREAS FOR OFFICE USE ONLY
<br />· Dade City: (352) 521-5144 FAX (352) 521 NCY: ~., SEa,.
<br />13852 17th St.. Oade City .
<br />e New Port Richey: (72n 847-8126 FAX (7 NITS: /
<br />7530 Little Rd.. Rm. 210 New Port Richey TRICT:
<br />eland O'lakes: (813) 929-1266 FAX (813) NSTRUCTION
<br />4111 land O'lakes Blvd. (US 41), land
<br />THIS APPUCATlON MUST BE TYPEO OR CEIVED:
<br />AND IS VOID IF NOT PERMITTED WITHIN
<br />. --- ... - _I
<br />IS nflSAPPLiCATiONTHE-RESULr-OFA-srOPwoRKORoEiiciiiNoiice-OF-vioLATiON?-----y-=-NZ------------.
<br />6 DWNER'S NJ.Md~/:f:i!;';;{l:.J:7~~~f;/-L{' .. PHONE I (!t.:2:i.1 5:.3;), .. qfoo I
<br />9 JOB LOCATION: - - - ___ _..........k_ ,---=--- ---~~5$t<sUBDIVISION:
<br />~ PARCElIDl:Sa T ~ R.il..L SU~ BLK = lOT ~PRDJECT' TAl -lDTSIZE _X_
<br />!Ii! OWNER'S PRESENT ADllAESS:.to 5b U. rk III e- oJ i'I/II7/eDP. Cf1Y. n: lilli """'/>oLe- STAlE: p,~ ZlP: :'\"- 'Vol
<br />::
<br />o FEE SIMPLE TITLEHOLDER'S NAME M other than OWner):
<br />address (if applicable): CITY: STATE: ZIP:
<br />----------------------------------------------------------------------------------------------------------
<br />
<br />DESCRIPTlON OF WORK: J..M h /)~ If}--i- 6AYlod~--R
<br />6 LMNG ARfA PATIO: .. GARAGE; ENTR'f TOTAl UNDER ROOF:
<br />9 # BEDROOMS -# BATHROOMS --2-. _ TYPE CONSTRUCTION: 0 BLOCK . FRAME 0 OTHER:
<br />ClJ FILL Y _ N -""
<br />~ IF MOBILE HOME OR RV: MAKE YEAR SIZE
<br />i=
<br />~
<br />a: WORK CODE
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<br />CI)
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<br />PERMIT#:
<br />II III IV
<br />BY:
<br />
<br />&l VI
<br />
<br />FEES BLOCK
<br />
<br />PLANS ON FILE? 0 NO 0 YES
<br />MODEL NAME
<br />
<br />PRE.PAlD PLANS FEES: $
<br />
<br />PLANS FEE: $
<br />
<br />VALUATION $ "75; 5'60 RECEIPT #:
<br />BO;;D,NG-COMPANy~----~~~-------------------------------________________________
<br />::.:: ADDRESS: CITY: STATE: _ ZIP:
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<br />cS ARCHITECT/ENGINEER: Tilt..- E~;/\j fr'O<J/)
<br />a:w ADDRESS: /40' AI. ~Aa ~,.;. ~ol CITY: T...""",
<br />,
<br />j:
<br />o MORTGAGE LENDER:_
<br />ADDRESS: .
<br />
<br />BUILDING: $
<br />
<br />STATE: f:1:.... ZIP:
<br />
<br />'3 '? ~o"/
<br />
<br />---------_u__________________________.._._________________________________________
<br />
<br />CITY:
<br />
<br />STATE: _ ZIP:
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<br />CONTRACTO~-. ~ Q Ii i ~()R<;, //1/c..,
<br />SIGNATURE:~ . ~ -' ~i ~ PHONE I I m.. I M&r ? ? 09
<br />>< AllORESS,5, . . -:... ,,-:_ -. _ CITY. ~A STAlE: L:L ZlP: 3a!,,/()
<br />g STATE UC, Qf applicable) C!..6eO'l-Q5'02S1. PASCO CO COMPUTER 10': q;yq tl-
<br />cS TG~ If-.cscn
<br />g ELECTRICAL~TRAC~~ ~k'k'.' /IV C.
<br />(,J SIGNATURE:.. ' ] ~~ PHONE' ( ~ l q3 s - ~Cft/.J
<br />g ADDRESS: -...: - CITY. 'Tt2rl-# nq . ST.IIE::€k. ZlP: 33&, oq
<br />~ STAT< UC I ~, ~~ E C anI? R tJ. . MScO Cl} cOMPIITER Ill#: I;?t? aPAI ,
<br />U POWER CO: .!i.fL!:. SAWPOlf;~ AMPS: ~ fb ( ')
<br />Aobe;,,+ Mv....,.",/,
<br />MECHANICAL CONTRACTOR:
<br />SIGNATURE:
<br />ADDRESS: /'
<br />STATE UC , Of apPicablel_
<br />o NEW 0 ALTERATION VALUATION: $
<br />
<br />ELECTRICAL
<br />FEE: $
<br />
<br />PHONE' (_I
<br />CITY: - ,..------r---' STATE:
<br />...... PASCO CO COMPUTER 101: _
<br />(Requiredl
<br />
<br />MECHANICAL
<br />FEE: $ .
<br />
<br />~ ZIP:
<br />
<br />PlUMBING CONTRACTOR: '
<br />SIGNATURE:
<br />ADDRESS: ~
<br />STATE UC I Of applicable) ,
<br />, FIXTURES: SEPnC PER ,
<br />
<br />- PHONE' I_)~
<br />CFrf. ... srA~ :.. ZIP:
<br />, PASCo CO COMPUTER 101:
<br />SEWER: WATER:
<br />
<br />PLUMBING
<br />FEE:
<br />
<br />$~
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<br />.. -'-.~~'" ('. ~, ..10
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<br />OniER CONTRACTOR:
<br />. ...... C!~ PHONE' ( _ )
<br />~ '" :l\g~ CI'TY: STATE: _ ZIP:
<br />.~ ~ ~~1.u Of applicable) PASCO CO COMPUTER 101:
<br />;~ '; '~O CTOR: VALUATION: S
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<br />~ ~ ~ ~;;;---u-----------~;-----____--------~;----u---------u__ RADON
<br />
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<br />\ ~1t~iL--~-----------------------_________________________________________________ ~
<br />
<br />~.. .: ~.' .. il... N' $2,SOO IN VALUE DO NOT NEED TO TO. T., 'A.. L B. UILDING PER. MIT. F EE:..'
<br />": 2.1JlPlIl POST A "NOTICE OF COMMENCa.1eNr ,...,.. ."""!
<br />\ ~;,: :-;.... . !.. ".. ." .. :. ~-,:\ !
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<br />: .-,:..-, t IIOTHTHEDWNER-CD~~~.~~.1lEAo.. ~~.:i::: I
<br />'i .''''''':~ SIGN THE REVERsE SlOE Of TIIS W'~i_..:J~;:.:.::.::' ........:;..;... .......,
<br />..~ """" ~ Of- RlAII AaEAsED 1lERlA~ 1/91 -~~ AND I\lU NOr !IF.""..,.." ov.......... _._.___
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<br />FEE:
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