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. PASCO COUN U~L ING ERMIT APPLICATION CtfNTRAL PERMITTING OFFICES: Dade City: (352) 521-4279 Fax (352) 521-4 8 ~ 14236 - 6th Street, Suite 203. Dade City r;c UPANCY: SEQ#: New Port Richey: (727) 847-8126 Fax (7 7) 847 01 . 7530 Little Road, Room 210, New Port chey :X N. OF UNITS: Land 0' Lakes: (813) 929-1266 Fax ( 3) 929-1307 . 4111 Land 0' Lakes Boulevard (U.S. 4 ), Land 0' Lakes Ire District: Permit#: ~' THIS APPLICATION MUST BE TYPE OR PRINTED IN INK Type of nstructlon: "f11 IV V VI AND IS VOID IF NOT PERMITTED THIN SIX MONTHS D Description of Wort<: E S C R I P T I o N Is this Application th N L/'" o Owner's' Name: Phone #;J1X3 ) 7'2 _ q(p cJD W Job Location: 3 q DO 7 Subdivision: ~ ParcellD#: s--'-3L T d&, R~Ub t?OBIk~Dt O..;)Z-OProject# TAZ Lot Size X R Owner's Present Address: 3Q(Xn l5UU Jay fJU..e City: 2t'f~yrhILts State: P( Zip: 33sL/.J- Fee Simple TItleholder's Name (If Other than Owner): Address (If Applicable): City: State: Zip: tJ tift(, r)Dfrt.R/lf ;2'TTf..?P?hi1/bClJI1, ;) 1 tc Y3~!310C()t4 I . Patio: Garege: Entry: # of Bathrooms: Type of Construction: 0 Block 0 Frame 0 other: By: Living Area: # of Bedrooms: Total Under Roof: Fill: Yes No If Mobile Home/RV, Make: Wort< Code Model Name: Valuation $ Year: Size: Prepaid Plans Fees: $ Plans on File? 0 No 0 Yes Receipt # C;" 3'5.3 g FEES BLOCK , Plans Fee: $ BUilding: $ o T H E R Bonding Company: Address: ArchitectlEngineer: Address: Mortgage Lender: Address: state: _ Zip: City: City: City: State: _ Zip: State: _ Zip: Contractor: Print Name: Phone # ( City: state: ~ Zip: Pasco Co. Computer 10# Signature: Address: State License # (If applicable) Electrical Contractor: Signature: Address: State License # (If Applicable) '''-.._,' C Power Co.: 0- - N T .R A C T G R Pririt Name: Phone # ( City: State: _ Zip: PasCC1 Co. Computer 10# Sawpole: AMPS: CeK'J rint Name: ~ G t (Ale; L Phone#2"n ) ~~ - diDO City: N .,p State: PL Zip: ~L{~ e~co Co. Computer 10# lff5-j~- 51 ,~. 6 lJ (Required) Electrical Fee: $ Mechanical Fee: $ Plumbing Contractor: Signature: Address: State Ucense # (If Applicable) # of Fixtures: Septic Per.,#: Print Name: Plumbing Fee: $ Phone # ( City: State: Zip: Pasco Co. Computer I~ Sewer: Water: Well: Other Contractor: Print Name: Signature: Address: State License # (If Applicable) Type of Contractor: 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 $ - NOnCE **- BOTH THE OWNER AND CONTRACTOR qF RECORD (LICENSE HOLDER) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION EDITIONS OF THIS FORM RELEASED BEFORE 03105 ARE OBSOLETE . . dv/pc93043032 Rev. 311/05