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PASCO COUNTY BUILDING PERMIT APPLICATION CENTRAL PERMITTING OFFICES: Dade City: (352) 521-4279 Fax (352) 521-4298 14236 - 6th Street, Suite 203, Dade City New Port Richey: (727) 847-8126 Fax (727) 847-8901 7530 Little Road, Room 210, New Port Richey Land 0' Lakes: (813) 929-1266 Fax (727) 929-1307 4111 Land 0' Lakes Boulevard (U,S. 41), Land 0' Lakes OCCUPANCY: SEQ#: NO. OF UNITS: Fire District: Permit#: THIS APPLICATION MUST BE TYPED OR PRINTED IN INK AND IS VOID IF NOT PERMITTED WITHIN SIX MONTHS Type of Construction: II III IV V VI Date Received: By: Is this Application the. o Owner's Name: W Job Location: N ParcellD#: S ~ T &l A R..2lL Sutt)~ BI~ ot cYJ"'lO>>roject # ~ Owner's Present Address: City: Zt-(h. lfh"' \ \~ N Phone # ( ) Subdivision: TAZ Lot Size State: f=\ Zip: x ~4.Q. Fee Simple Titleholder's Name (If Other than Owner): Address (If Applicable): City: ~ Description of Work: .In'bb \\l~ (' OrfeY'~ ~h "'ll~ I~ yt")O I S Living Area: Patio:. Garage: Entry: C R # of Bedrooms: # of Bathrooms: Type of Construction: 0 Block I P T I o N State: Zip: u"\t+n ~) Total Under Roof: o Frame 0 Other: Fill: Yes No FEES BLOCK Plans Fee: $ If Mobile Home/RV, Make: Wor1< Code Model Name: Valuation $ . ~ lcH''?:>. c.2P Year: Size: Prepaid Plans Fees: $ Plans on File? 0 No o Yes Receipt # Building: $ o Bonding Company: T Address: H Architect/Engineer: E Address: R Mortgage Lender: Address: City: State: _ Zip: Contractor: A-Gun.\l~~"i~ \1\('. Print Name: KO~(t ~; br~') Signature: ~ Phone # (1/.131) ~, tReo Address:~ cne€~ "6\-<o.-@City: ~State:~Zip: ~~ State License # (if applicable) 14~'1 Pasco Co. ComputerlD# 0\ ~\rj . Electrical Contractor: ~()~ E\eC::iY ic. Print Name: ~ (y U L I Phone#(<613) qOl -<tJ~? A~City: ~State: A Zi~~~ Pasco Co. Computer 10# 0'_ Sawpole: AMPS: City: State: _Zip: _ City: State: _Zip: Address: State License # (If Applicable) Power Co.: Electrical Fee: $ C o N T R A C Address: T o State License # (If Applicable) R 0 New 0 Alteration Valuation: $ Mechanical Contractor: Print Name: Mechanical Fee: $ Signature: Phone # ( City: State: _ Zip: _ Pasco Co. Computer 10# (Required) Plumbing Contractor:A-CVU.0hb~~~ \('(print Name: "t?Cbt"ft..J. G((~umbing Fee: $ Signature: Phone # (~J3> ) S <6 ~-~ Addres~:5t1. r'L \'1. -I City: Ill~tate: ,c, Zip: ~3l.f State License # (If Applicable) , Pasco Co. C mputer 10# ~ 4Dlf I # of Fixtures: _ Septic Per. #: Sewer: _ Water: _ ell: Other Contractor: Signature: Address: State License # (If Applicable) Type of Contractor: Print Name: Other Bldg. Fee: $ Phone # ( City: State: Zip: Pasco Co. Computer 10#- - Valuation; $ JOBS UNDER $2,500.00 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT." TOTAL BUILDING PERMIT FEE $ [; l I f I r Other Fee Type: Amount: $ Receipt #: Radon Fee: $ dv/pc93043032 . ..,- NOTICE --* ONTRACTOR OF RECORD {ll THE REVERSE SIDE OF THIS RELEASED BEFORE 03/05 A t I