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PASCO COUNTY BUILDING PERMIT APPLICATION CENTRAL PERMllTlNG OFFICES: SHADED AREAS FOR OFFICE USE ONLY · Dade City: (352)521-5144 FAX (352) 521-5149 OCCUPANCY. SEQ#' 13852 17th St.. Dade City '. · New Port Richey: (727) 847-8126 FAX (727) 847-8901 NO. OF UNITS: 7530 Uttle Rd.. Rm. 210 New Port Richey FIRE DISTRICT: · Land O'Lakes: (813) 929-1266 FAX (813) 929-1307 4111 Land O'Lakes Blvd. (US 41), Land O'Lakes TYPE CONSTRUCTION THIS APPLICATION MUST BE TYPED OR PRINTED IN INK DATE RECEIVED: AND IS VOID IF NOT PERMITIED WITHIN 6 MONTHS ---------------------------------------------------------------------------------------------------------. IS THIS APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? Y _ N_ 6 OWNER.SNAM~_tf4:2r11f ~ ~"e Gahr PHONE> r.aJ..3.: ::is - <J;;y..'jj g JOB LOCATION: ~-~- _ s:f SUBDIVISION: -=P"ne('Cl"_ ~ PARCELlD#: s..LL T diL R ~ SUBcn/O BLK CfJW LO~ PROJECH :w _ LOT SIZE _X_ ~ OWNER'S PRESENT ADDRESS: S(?-.c. 6lISTS4-. Cl1Y: '7 P\,h\r\\\\~ V STATE: FI ZlP: 3:2,,,46 ~ I o FEE SIMPLE TITLEHOLDER'S NAME (If other than owner): address fit applicable): CITY: STATE: ZIP: ~~~~~~;;;~-~;~~~;~e~\Q~;-~~\;;;~~;---~;-2e--~-;-~-i~;;--------------------------------------- ~ LIVING AREA PATIO: GAAAGE: ENTRY: TOTAL UNDER ROOF: g · BEDROOMS - # BATHROOMS -- _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: CXI FILL Y _N_ ~ IF MOBILE HOME OR RV: MAKE i= ~ ex: WORK CODE u en w eVALUATION $ ;;>3(0 I. 00 \'\b'74~ PERMIT#: II III IV BY: V VI YEAR SIZE PLANS ON FILE? 0 NO 0 YES MODEL NAME PRE.PAlD PLANS FEES: $ RECEIPT .: --------------------------------------------------------------------------------- BONDING COMPANY: ~ ADDRESS: u o c6 ARCHITECTIENGINEER: a: ADDRESS: w ~ o MORTGAGE LENDER: ADDRESS: CITY: STATE: _ ZIP: ~~~;~~-~~~~;;~i~~----------------------------------- SIGNATURE: - . c-.. PHONE.' ' l Jt../7' 1.'2.f) '" ADDRESSJJ/;;l N 'l9'l):',i- . CITY. ~n~ 5TATE~ Z1P3.~~ g STATE UC . nf apPhcable)C.~CC:f')&S 00 PASCO CO COMPUTER 10.: 0 I d (p'./S -l CXI a: g ELECTRICAL CONTRACTOR: ~ SIGNATURE: I- ADDRESS: ~ STATE UC # (if applicable) U POWER CO: Cl1Y: STATE: _ ZIP: CITY: STATE: _ ZIP: PHONE' (-I Cl1Y: STATE: _ ZIP: PASCO CO COMPUTER 101: SAWPOLE: AMPS: MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . (if appllcablel o NEW 0 ALTERATION VALUATION: S PHONE. (-I CITY: STATE: _ ZIP: PASCO CO COMPUTER 101: (ReqUired) PLUMBING CONTRACTOR: SIGNATURE: ADDRESS: STATE UC . (If applicable) # RXTURES: SEPTIC PER. PHONE. (-I Cl1Y: STATE: _ ZIP: PASCO CO COMPUTER 101: SEWER: WATER: WEu.: OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # fit apphcablel TYPE CONTRACTOR: PHONE' (_) Cl1Y: STATE: _ ZIP: PASCO CO COMPllTER 10#: VALUATION: S --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: S RECEIPT.: --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOnCE OF COMMENCEMENr FEES BLOCK PLANS FEE: $ BUILDING: $ ELECTRICAL FEE: $ MECHANICAL FEE: $ PLUMBING FEE: $ OTHER BLDG. FEE: $ RADON FEE: $ $ TOTAL BUILDING PERMIT FEE: · · · · NonCE . . . . BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holderl MUST READ AND SIGN THE REVERSE SIDE OF THIS APPUCATION IJ)eImrt lorm 101911 EDITlONS OFJH'~FOR~ qF.!-EASED8EF:I")R~ 1/91 ARE.,[3~'" FIT ANDjVI" .. "~ "~~c~r"~"", C)~' "F\\L. "::I]..tLl.