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<br />PASCO <br />CENTRAL PERMITTING OFFICES <br />· Dade City: (352) 521-5144 FAX (352) 521 <br />13852 17th St., Dade City <br />· New Port Richey: (727) 847-8126 FAX (7 <br />7530 Uttle Rd., Rm. 210 New Port Riche <br />· land O'lakes: (813)929-1266 FAX (81 <br />4111 land O'lakes Blvd. (US 41),land <br />THIS APPUCATION MUST BE TYPED 0 <br />AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS <br />is rn,s-;PPLiCATiQi:jTHE-AESULT -OFA-ST~-woiiK -ORDER OR- NOTICE-OF VioLAnoN?- - - - - y-=:'- i-jC - - -- - -- - ---. <br />.R'S NAM~ R <l: f 'I", \ ~ .-.-" c, PHONE I 1'27) 7.< 'I. '7~. L/ <br />CATION: 3 '7<) c 1 (J.A.. e .:. c!) 0..,.;) oM i ' SUBDIVISION: (Y'(c~::::-\t....~-~! --.)( (,6 <br />EL 10#: S --LL T ~ A ~ SUB~ ; LOT 0C!2- PROJECT # Tftl. _ LOT SIZE _X_ <br />ER'S PRESENT ADDRESS: / (.. (') 3 L 4 J11 w ~.ll.. c {' CrrY: L.u ~ "i l-eo 1 STATE: I':::c. ZIP:.5 ? S <.. /.J <br />:;: CIA..... r <:. I <br />e FEE SIMPLE TITLEHOLDER'S NAME (if other than owner): <br />address M applicable): CI1Y: STATE: ZIP: <br /> <br /> <br />PERMIT#: <br />II III IV <br />BY: <br /> <br />V <br /> <br />VI <br /> <br />DESCRIPTION OF WORK: <br />G LIVING AREA: i (.. 5'Y PATIO: GARAGE: ENTRY: TOTAL UNDER ROOF: <br />9 # BEDROOMS --L- # BATHROOMS ~. _ TYPE CONSTRUCTION: ~LOCK 0 FRAME 0 OTHER: <br />m FILL Y _N.L. <br />~ IF MOBILE HOME OR RV: MAKE YEAR SIZE ,-> L FEES BLOCK <br /> <br />a: WORK CODE PlANS ON FILE? 0 NO 0 YES PAE-PAlD PLANS FEES: $ (o(Q PLANS FEE: $ <br />u __ <br /> <br />* "m-'7-~-~-~~-~-~~:~~~:~----m-__mm~~~E~~~~J0_~_J5-zbo1fLLDING S _._ <br /> <br />BONDING COMPANY: <br />::.::: ADDRESS: - CITY: STATE: _ ZIP: <br />u <br />e <br />~ ARCHITECT/ENGINEER: <br />cc ADDRESS: CrrY: STATE: _ ZIP: <br />w <br />:%: <br />l- <br />e MORTGAGE LENDER: <br />ADDRESS: CrrY: STATE: '_ ZIP: <br /> <br /> <br />-------------------------------------------------- <br /> <br /> <br />--------------------------------------------------------------------------------- <br /> <br />,CTOR: IOU e. VI.. ~ Q 4-..".,.. 5 1'- c~ -t--"v <.. <br />URE: '/ ~ PHONE 1/ (gol.> ) -<&f II ?C ;Y-L(' <br />ESS: I (j, . r__... 4-~ .'.... j-~ t' (CITY: /' / ~ STATE: ~ Z: .s C I <;y <br />CD UC 1/ (if applicable) - <.. : L , PASCO CO COMPUTER 101/: C) f..L/ I;) <'5 r+- <br /> <br />~ ~ AA. S. ~ ~ cz:h ELECTRICAL <br />~ ELECTRICAL CONTRA :' " I (}, 'L I' ~ ~-z:;J C- '-...... FEE: $ <br />u SIGNATURE: PHONE 1/ Ei2... l i? ~ - rJ~ 1-. <br />g ADDRESS ~. - :ift!.2!. CITY:~*-!-~S:TE~Z1P~",.~/..,.. <br />5 STATE UC 1/ (if~pllcable) tF C. 1300 I G.," (' PASCO co COMPUTER 10#: <br />U POWER CO: '7JJA:) G pi2 c;; c;. (U ( SAWPOLE: t; t!) ~ Y? AMPS: <br /> <br />MECHANICAL CONTRAC <br />SIGNATURE: <br />ADDRESS: ~, <br />STATE UC # (if applIcable) <br />~ NEW 0 ALTERATION <br /> <br />PlUMBING~O CTOfl-~ ~(1tAJO flauti:,Y06 tY/z <br />SIGNATUR . _t<~ _ HONE' j}J.L) H12- 9/33 <br />ADDRESS: 47i.r.- M (jJ.lc.therf A1e- CITY: 7~,Q.. STATE: B- ZIP: ~~f <br />STATE U.C' ~f ipP./icable) I.C -CD.c'Tnr PASCO CO COMPUTER 101: <br />, FIXTURES: 'II SEPTIC PER , SEWER:!.... WATER: J WEl..L; <br /> <br /> <br />'"' ~ MECHANICAL <br />M< FEE: $ <br />-=s 3<:'''74 <br /> <br />PLUMBING <br />FEE: <br /> <br />$ <br /> <br />OTHER <br />. BLDG. <br />FEE: <br /> <br />$ <br /> <br />OTHER CONTRACTOR: <br />S~NATURE ~E'(____) <br />ADDRESS: CITY: STATE: _ ZIP: <br />STATE UC , ~f applicable) PASCO CO COMPUTER 10#: <br />TYPE CONTRACTOR: VAlUATION: S <br /> <br />~~;;;;;;;;-~\\--e:------~~;;~i-j;:)-------;~~;;;-=_12------------ <br /> <br />fpennit form 10191) <br />_NS OF THIS FORM RElEASED BEFORE 1191 ARE OBSOlETF AND Will NOT BE Acx.'t.t'I~u BY CENTRAl PERt.lmNG STAFF <br />PC93043032JG ftICDl <br /> <br />....NOl1CE.... <br />BOTH THE OWNER AND CONTRACToR OF RECORD (Ucense Holder) MUST READ AND <br />SIGN THE REVERse SIDE OF THIS APPUCATION <br />