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fJ QQ~ CENTRAL PERMlmNG OFFICES: · Dade City: (352) 521-5144 FAX (352) 521-5149 13852 17th St.. Dade City · New Port Richey: (72n 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 PERMITIED WITHIN 6 MONTHS PASCO COUNTY BUILDING PERMIT APPLICATION SHADED AREAs FOR OFFICE USE ONLY OCCUPANCY: SEQ#: NO. OF UNITS: RRE DISTRiCT: TYPE CONSTRUCTION: DATE RECEIVED: II PERMIT#: m N BY: VI v ---------------------------------------------------------------------------------------------------------- IS THIS APPLlC.ATlON THE RESULT OF A~S OP W~R.K ORDER OR NOTICE. OF VIOLATION? Y _ N_ G OWNER'SNAME:, '~f1,-~B - .CUi.S. ,"t1-~HONE# (~) lR~ _ j(QC, / 9 JOB LOCATION: ,5cr3d-() -" _~, ~ _ _ "S'USOIVISION: CD PARCEL 10#: S_ T - R - SUB BLK _ LOT _ PROJECT # TAZ _ LOT SIZE _x_ ~ OWNER'S PRESENT ADDRESS: 3'l'l di\ ~ P. \/.R. CrTY: <<'P" yt h ,- i (", STATE: FL ZIP: '0'; S'I ;;J 3: o FEE SIMPLE TITLEHOLDER'S NAME Of other than owner): address (if applicablel: CITY: STATE: ZIP: ~~;;~;;:;;~-y--~---:;:--~~-->y::;P;i-r:--mn-----mn---n----------__n_____ ~ UVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: 9 # BEDROOMS - # BATHROOMS -- _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: CD FILL Y _N_ ~ IF MOBILE HOME OR RV: MAKE i= Q. a: WORK CODE PLANS ON FILE? 0 NO 0 YES ~ MODa NAME C 'd VALUATION $ {Or> () RECEIPT #: BUILDING: $ -------------_Jl_________________________________________________________________ BONDING COMPANY: :.: ADDRESS: u o ~ ARCHITECTIENGINEER: ffi ADDRESS: j: o MORTGAGE LENDER: ADDRESS: YEAR SIZE PRE-PAlO PLANS FEES: $ CITY: STATE: _ ZIP: CITY: STATE: _ ZIP: CITY: STATE:' ~ ZIP: --------------------------------------------------------------------------------- CONTRACTO : SIGNATURE: :.: ADDRESS: 8 STATE UC # (if applicable) -' CD a:: 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) , AXTURES: SEPTlC PER # PHONE# (_) CITY: STATE: _ ZIP: --, PASCO CO COMPUTER 10': SEWER: WATER: WElL: OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # (if applicable) TYPE CONTRACTOR: PHONE# (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER /0#: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: $ RECEIPT#: --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENr TOTAL BUILDING PERMIT FEE: ....NOTICE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPUCATION FEES BlOCK PlANS FEE: $ 8.ECTRlCAL FEE: $ MECHANICAL FEE: $ . OTHER BI.DG. FEE: $ RADON FEE: $ hS (permit form 1(191) EDfTIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC93043032/G (OVER)