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CENTIW. PERMlmNO OFFICES: · Dade City: (352) 521-5144 FAX (352) 521-5149 13852 17th St., Dade City · New Port Richey: (727) 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 PERMllTED WITHIN 6 MONTHS ---------------------------------------------------------------------------------------------------------- IS THIS APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? Y _ N_ 6 OWNER'S NAM%~J~' t'~G ~ PHONE # &.L3.... i '7If..!L _ 3 'I' "1-"1 9 JOB LOCATION: /1! . ~ ~~ )/JliS SUBDIVISION:-r~~ //MJ: 111V /16./F ~ PARCEL 10#: S -Ia- T ~ R..;!.L SUB<2i::.\aa BlJ(~/'1O OT ~ROJECT # TAl _ LOT SIZE _~ ~ OWNER'S PRESENT ADDRESS: SIr dJ..TI }) A ~N.. CIlY: 2FNY.R./I ILL)' STATE: FL ZIP: ."=3..~. 2- ~ o FEE SIMPLE TITlEHOLDER'S NAME Of other than owner): address (if applicable): CIlY: STATE: ZIP: ~~~;1;~;;~;;;;~-RE::-z;;,F-S;~;.?~-~-;eV.8~-Pim8MVF-m--m----m---------------- Q UVING AREA: PATIO: GE: ENTRY: TOTAL UNDER ROOF: ...:57d2. 9 # BEDROOMS - # BATHROOMS -. _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: aJ FILL Y _N_ ~ IF MOBILE HOME OR RV: MAKE i= a.. CE WORK CODE (.) en w c PASCO COUNTY BUILDINO PERMIT APPLlCAnON SHADED AREAS FOR OFFICE USE ONLY OCCUPANCY:SEQ#: NO. OF UNITS: ARE DISTRICT: 'TYPE CONSTRUCTION: DATE RECEIVED: fI PERMIT#: III IV.. V BY: VI YEAR SIZE FEES BlOCK PLANS ON FILE? 0 NO 0 YES MODEL NAME PRE-PAlO PLANS FEES: $ PlANS FEE: $ VALUATION $ RECEIPT #: BUILDING: $ --------------------------------------------------------------------------------- BONDING COMPANY: ~ ADDRESS: CIlY: STATE: _ ZIP: (.) o ca ARCHITECT/ENGINEER: ffi ADDRESS: CIlY: STATE: _ ZIP: j: o MORTGAGE LENDER: ADDRESS: CIlY: STATE: ~ ZIP: --------------------------------------------------------------------------------- CONTRACTOR: SIGNATURE: ~ ADDRESS: g STATE UC # ~f applicable) ~ aJ a: g ELECTRICAL CONTRACTOR: (.) SIGNATURE: ~ ADDRESS: S STATE UC # (if applicable) (.) POWER CO: PHONE # (_) CIlY: STATE: _ ZIP: PASCO CO COMPUTER 101: SAWPOLE: AMPS: ELECTRICAL FEE: $ MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # (if applicable) o NEW 0 ALTERATION VALUATION: $ PHONE# (-l CIlY: STATE: _ ZIP: PASCO CO COMPUTER 101: (Required) MECHANICAL FEE: . $" PLUMBING CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # Of applicable) # FIXTURES: SEPTIC PER # PHONE# (_) cnv: STATE: _ ZIP: PASCO CO COMPUTER 101: SEWER: WATER: W8.L: PLUMBING FEE: $ q OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # (if applicable) TYPE CONTRACTOR: -PHONE#(_) CIlY: STATE: _ ZIP: PASCO CO COMPUTER 10#: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: $ RECEIPT#: RADON FEE: $ .... S --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENr TOTAL BUILDING PERMIT FEE: (permit fcnn 101911 EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMrmNG STAFF PC930430321G IOVFR\ ....NonCE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPUCATlON