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PASCO COUNTY BUILDING PERMIT APPLICATION CENTRAL PERMITrING 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 O' Lakes Boulevard (U .S. 41). Land 0' Lakes OCCUPANCY: SEQ#: NO. OF UNITS: Fire District: Permlt#: THIS APPLICATION MUST BE TYPED OR PRINTED IN INK AND IS VOID IF NOT PERMITTED WITHIN SIX MONTHS Type of Construction: " III IV V VI Date Received: By: Is this Application the Result of a Stop Work Order or Notice of Violation? Y o Owner's Name: W Job Location: N ParceIID#: S T E R Owner's Present Address: N Project # Phone # ( ) Subdivision: T AZ Lot Size State: __ Zip: R Sub Blk Lot City: x Fee Simple Titleholder's Name (If Other than Owner): Address (If Applicable): City: State: Zip: D Description of Work: E S C R I P T I o N Living Area: # of Bedrooms: Patio: # of Bathrooms: Garage: Entry: Type of Construction: 0 Block o Frame Total Under Roof: o Other: Fill: Yes No If Mobile HomefRV, Make: Work Code Model Name: Year: Size: FEES BLOCK Plans Fe'e: $ Prepaid Plans Fees: $ Plans on File? 0 No 0 Yes Valuation $ Receipt # Building: $ o Bonding Company: T Address: H Architect/Engineer: E Address: R Mortgage Lender: Address: City: State: _ Zip: Contractor: ~ S'9^ C""'rJ Print Name: gb~~ /{,;tev S. Signature: ~' Phone # ( J Address: /0/ e" LL'm=" A-<-. c: City: &Jx-(Ih:,tate: FL Zip: 3;/60/ State License # (if applicable) E-x::>ooc;:d/f 7 Pasco to. Computer 100 Electrical Contractor: / ~7'''''' s S'7^ Co'f/Print' Name: ~.b- Signature:~ Phone # ( ) Address: 70/ 5 Lc'#'VIC>Y'\ /lc..---e City: hi'u/kState: rc.. Zip:.5S'6c/ State License # (If Applicable) ~ .5c;:>ocx::>Lf f 7 Pasco Co. Computer 10# Power Co.: Sawpole: AMPS: City: State: _ Zip: City: State: _ Zip: eo7'~"'S , Electrical Fee: $ C o N T R A C T o R Mechanical Contractor: Print Name: Mechanical Fee: $ Signature: Address: State License # (If Applicable) o New 0 Alteration Valuation: $ Phone # ( City: State: _ Zip: Pasco Co. Computer 10# (Required) Plumbing Contractor: Signature: Address: State License # (If Applicable) # of Fixtures: _ Septic Per. #: Print Name: Plumbing Fee: $ Phone # ( City: State: _ Zip: Pasco Co. Computer 10# Sewer: _ Water: Well: Other Contractor. Signature: Address: State License # (If Applicable) Type of Contractor: Print Name: Other Bldg. Fee: $ Phone # ( City: State: Zip: Pasco Co. Computer lOr- Valuation: $ Other Fee Type: Amount: $ Receipt #: Radon Fee: $ JOBS UNDER $2,500.00 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 (LICENSE HOLDER) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION EDITIONS OF THIS FORM RELEASED BEFORE 03105 AR6.-0BSOLETE