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PASCO COUNTY BUILDING PERMIT APPLlCAnON SHADED AREAS FOR OFFICE USE ONLY CE,NTRAL PERMlnlNG 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 little 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 PERMITTED WITHIN 6 MONTHS iSTHIS-APPUCATIONTHE- REsuLi--oFA-i-QPWORK-O-oERORNoii-E-oFVioiAiiON?---- -Y-=-N~- - -- - -- ----- -3~ -451 50WNER'SNAME:' -, + PHONE# (~) 1~~ - _or <.::Tl70 9 JOB LOCATION: UBDIVISION: DA K 1=2, - f\. ' ~E I co PARCEL 10#: T..9L2 R ~ ~ur,D1IDBUCClI1lo PRQ.}.ECI1,... TAl _ lOT SIZE _x ~ OWNER'S PRESENT ADDRESS:'7~ HIeJf:ft.an/1 I rf")P CITY:z.Fl)h!JrhJI L~STATE: J::-L ZIP: ,~,~,~ ~ FEE SIMPLE TITLEHOLDER'S NAME (if other than owner): address (if applicable): CITY: STATE: ZIP: ~-E~~~~;~~~-~;;;;~;rn-~il~fil-(jr~NPqki8ipmlU5[n-Frjjiiidj(jJf)(i[jfi;;7fti) {1J/llP 5 LIVING AREA: PATIO: GARAGE: ENTRY: TOTAL UNDER RooR 9 # BEDROOMS _ # BATHROOMS -- _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME )(OTHER: co FILL Y _N_ ~ IF MOBilE HOME OR RV: MAKE i= a.. a: WORK CODE.FPJ PLANS ON FILE? 0 NO ~ . MODEL NAME w eVAlUATION $ IRI WUJti ;:J/) YEAR ~ SIZE PRE-PAID PLANS FEES: $ RECEIPT #: --------------------------------------------------------------------------------- BONDING COMPANY: ~ ADDRESS: CITY: STATE: _ ZIP: u o ffi ARCHITECT/ENGINEER: ffi ADDRESS: CITY: STATE: _ ZIP: :I: ~ o MORTGAGE LENDER: ADDRESS: CITY: STATE: _ ZIP: -------- ----- CONTRA TOn. f' SIGNATU .~~ P~ONEJ.. ~ I ~ . I ~ ADDRESS: Vt1rY: c .l-tC{:K.~ LL STATE: g STATE L1C # (if applicable) " j PASCO CO COMPUTER 10#: I ~~:;~~:~~~:~~np:l14lblbP, ~ STATE L1C # (if applicablefJAA~t.i q() PASCO CO COMPUTER 10#: { q U POWER CO: SAWPOLE: AMPS: MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE L1C # (if applicable) o NEW 0 ALTERATION VALUATION: $ PHONE# (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: (Required) OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE L1C # (if applicable) TYPE CONTRACTOR: PHONE# (_) CITY: STATE: _ ZIP: PASCO CO COMPUTER 10#: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: $ RECEIPT#: -~------------------------------------------------------------------------------- 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 MECHANiCAl FEE: J8 PLUMBING FEE: $ OTHER BLDG. fEE: $ RADON FEE: $ (permit form 10/91) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF PC93043032/G (OVER)