05-3993 - Laserfiche WebLink

Browse Search

PASCO COUNTY BUILDING PERMIT APPLICATION CENTRAL PERMITTING 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 Utile 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 PERMITTED WITHIN 6 MONTHS ---------------------------------------------------------------------------------------------------------. IS THIS APPLICATION THE RESULT OF A STOP W~K ORDER OR NOTICE OF VIOU\TlON? Y _ N_ ~ OWNER'S NAME: r^-c-c '4 W, <... ~ I""", dI PHONE # (~) "1 i Z - 2 q ~ <1 g JOB LOCATION: S & ~ t \ I 4 r::II .51: SUBDIVISION: ~ H f'A... ~ a:l PARCEL 10#: s...!l.. T ~ R 3:.L SUB ~ BU< e ~-100LOT ~ PROJECT # TAl _ LOT SIZE _X_ ~ OWNER'S PRESENT ADDRESS: ~- ~ ~ I '''t'il'' Crl-. CnY: 2cf''^ '( c\...~ [b STATE: j: L ZIP: 'US'"f'to ~ o FEE SIMPLE TITLEHOLDER'S NAME M other than owner): address M applicable): CnY: STATE: ZIP: ~ ~~:~-~;;;;;-6j~-:--s-::-ij~~-~t:---~~---:;~-~~~:~~=F-----------. g # BEDROOMS _ # BATHROOMS _' _ 'TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER: a:l FILL Y _N_ a IF MOBILE HOME OR RV: MAKE ~ Q. ex: WORK CODE o en w c PERMIT#: II III IV BY: v VI YEAR SIZE FEES BLOCK PLANS ON FILE? 0 NO 0 YES MODEL NAME PRE.PAlD PLANS FEES: $ PLANS FEE: $ VALUATION $ ~ 7(,.""" RECEIPT .: BUILDING: $ --------------------------------------------------------------------------------- BONDING COMPANY: ~ ADDRESS: o o a:l ARCHITECTIENGINEER: a:: ADDRESS: w ~ o MORTGAGE LENDER: ADDRESS: CrTY: STATE: _ ZIP: ~~~;;~;-----~:-7-----~-- -:~~-------------------------------------------- SIGNATU PHONE' I g I ~) b 1. 0 - (". ( It I ~ ADDRESS: c:> "'7 ,e . ~CnY: (' c....~ l ~ STATE: a ZIP: ~ ~ be c; g STATE UC . nf applicable) <.. 60 PASCO CO COMPUTER 10': ...I a:l a:: g ELECTRICAL CONTRACTOR: ~ SIGNATURE: .- ADDRESS: a STATE ue # (if applicable) o POWER CO: CI1Y: STATE: _ ZIP: CnY: STATE: _ ZIP: ELECTRICAL FEE: $ PHONe. (_) enY: STATE: _ ZIP: PASCO co COMPUTER lOt: SAWPOLE: AMPS: MECHANICAL CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # (if applicable) o NEW 0 ALTERATION VALUATION: $ MECHANICAL FEE: $ PHONE. l-) CrTY: STATE: _ ZIP: PASCO CO COMPUTER 101: (ReQUIred) PLUMBING CONTRACTOR: SIGNATURE: PLUMBING FEE: $ PHONE' (_) CITY: ACORESS: 51:&::: _ ZIP: STATE UC # nf applicable) # RXTURES: SEPTlC PER # ~OCOCOMPUTERIDt: SEWER: WATER: WELL: OTHER BLDG. FEE: $ OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE UC # fIf appllcablel 'TYPE CONTRACTOR: PHONE # (_) CI1Y: STATE: _ ZIP: PASCO CO COMPlJTER 101: VALUATION: $ --------------------------------------------------------------------------------- OTHER FEE TYPE: AMOUNT: S RECEIPT#: RADON FEE: $ $ --------------------------------------------------------------------------------- JOBS UNDER $2,500 IN VALUE 00 NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENr TOTAL BUILDING PERMIT FEE: ....NonCE.... BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPUCATlON lpeIIIIrt tonn 10/91) EomoNS OF THIS FORM RELEASED BEFORE 1191 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITIING STAFF