HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 190S.1-v
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Building Permit Application oh tio�9
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Planning and Development Services
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Building and Code Regulation Division perm`t� �c+e C°
2300 Virginia Avenue, Fort Pierce FL 34982 C111'
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: Electric
Address: 5942 Alexandria Cir Ft. Pierce, FL 34982
Property Tax ID #: 3410-503-0253-000-0 Lot No.
,Site Plan Name: Block No.
Project Name: Yanchko
Install 120V 20Amp Dedicated GFCI Circuit
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Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_L-eectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ftiof Construction: Sq. Ft. of First Floor:
'Cost of Construction: $ 700.00 Utilities: _ Sewer _ Septic Building Height:
NameAngeline Yenchko
Name: Walter Nasdi
Address: 5942 Alexandria Cir
Company:Sol Electric
City: Ft. Pierce State: _
Address:5500 SW 43rd Ter
Zip Code: 34982 Fax:
City: Ft. Lauderdale State: FL
Phone No.570-582-6971
Zip Code: 33314 Fax:
E-Mail:
Phone No754-423-4105
Fill in fee simple Title Holder on next page ( if different
E-Mailwnasi72@yahoo.com
State or County License EC1300 8044
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not
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Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
city:
P
S gnature ner/ Lessee/Co r for as Agent for Owner
Sign t e f ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
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The forgoing instrument was acknowledged before me
this day of . 20_ by
The forgoing instrument was acknowledg before me
this,day of 20 by
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Personally- nown Identification
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