HomeMy WebLinkAboutFt Pierce PIFL067 BuildingPermitApplication-EDC 6-24-20 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date _Vl I Permit Number:
. a ....'-.,. Building Permit Application
Pion ni g a;�d Oa,:e;
.Swidi^g nr' dr Core hftT:l�rJ tiO!?�+ 'S+;J•,
2300 Virgi^rc Avenue, Forr Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 1578 D,g.orgio Rd. Fort Pierce
Property°Tax ID b: 2428-133-0001-000-6 Lot No
Site Pian Name: Ft Pierce 150' PIFL067 IYlonopole Telecommunications Facility Block No.
Project Name: Ft Pierce 150 PIFI-W, Monopole Telecommunications Facility Ay--
DETAILED DESCRIPTION OF WORK:
Installing new 150'Telecommunications Tower and compound area
CONSTRUCTION INFORMATION:
Additional , ork to oe performed u.:der this permit—check a:i that apply,
_Iviechanical —Gas Tank _Gas Piping —Shutters Windcws,Doors
X Electric _Plumbing _Sarinklers Y Generator Roof Pitch
Total Sq. Ft of Construction: 2500 So. >t. of First Floor:
Cost of Constructions: S 175.000---- tlr;rities: Sewer _Septic Building height:
OWNERAESSEE: CONTRACTOR:
Name cI T e'f=B+el;�pme.t
_ _ Name'_Da0d Gra,re'o
Address:2320 Cascade Pointe Blvd.Suite 300 _ Company:ELECTRICAL DESIGN CONSULTANTS LLC
City_ Charlotte State NC Address: 1076 SE 14TH STREET
Zip Code: 28208 Fax:_.__ .____ __ City: STUART State:FL _�—
Phone Na. _ Zip Cade: 34996 Fax:
E-Mail: w� — _ Phone No 440-773-0311 —
Fill in fee simple Title Holder on next page(if different E-(vlail jnikles.Zgraneto.com
from the Owner listed above) State or County License CGC1514687 _
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _-
) of Appiicabia MORTGAGE COMPANY: X Not Applicable _
Name= +'I' rou Z John Kelly Name:
Addres>:_17 _Boulder Avenue Address:
City. TuLa State: OK City
Zip: 74119 Phone Lip: Phone:
FEE SIMPLE TITLE HOLDER: _Nct Applicable BONDING COMPANY: X Not Applicable
Name:.&Ly&L---jM Plastics CorI2 dame:
Address:_9fiD_giv�rsi pr" ive_" Address: --- --___
City: eville.tLC _- City:
Zip: 2BSDA Phone: 82$:252:8I55 x1250 Zip Pnone:!
OWNER/ CONTRACTOR AFFiDVIT: Ar,2: t,o^:s hz?rebv r ad I o_bta:r a permit tc dot ,e ,.4rF._ _
I certify'~at no'work or-rsta,lancr has o-nmenced prier?o, �.ssvance of a permit. -
Lt,L'•2 Corot}'R'`aKes"o reepre5cri-a ion:na:�K - -'i a_.tl'.0`rre t!,e perr^It rlo d c"-.:lc`he sLbje t s`ructure
4vriicFv is in cart ict�v t a�a appi tatste�ten.e Owl .,les bylaws or a tid c venznts at^ ay estr'ct or prohibit such
structure Piease r - ^._:r c review your deed for any restr:,-ons--rvrich^-ay apply'
In consideration_ e.._ . {;e,eby agree that I.viil,to a!:respects, c_-forTM :7±e .rork
in accordance ;Codes and St.Uuve County A^-endr`er s.
The follo'ty ng b.: .. are ene = undergoing a fu: concurrency rev;ev,:ro,m addbt:ans,
accessory strucrur"?, roc`:s. °er,Ces,wai75. s:s;-.•5, screen `oorns arc accessory Uses to another nor-resldertic
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE fiNE FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING. CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT,"
Signature of Owner/LesseeAt6ntractor as Ownef tracto i c., -iolde-
- QY\\C1
STATE OF NORTWn
Iy�q STATE OF#L�A5*
COUNTY OF O 1 COUNTY OF "Cu- ---
The r �i instr�tv, ovtedge e=or - ,a—ckno—wleo re me
- o h 20y of�ih 3t _ y
2C& by
eoow Xd1 (�Irav
Name f persor:mak ng st�atemert" Naive of person-making staten-:ent.
Personally Knr.•:n OR prcdviced ide��ivfiltl�!iew perso^ally Cnot+n �_pR produced lcentificatior
Type of identificat or, yia+r`` a L T(/L,�4'i�.,,— Tyne of Icen;ification
-1� JULIE NIKL.p s - --
� r. ,� Notary Pub
o State of Oh
NOTARY ,_ ;:v, ,:r::, # o My Comm. Ex res
(st natur lVot2r Public State c-' p:la C Z: r Y r-20
re of Notz blic Sta.e
My COMMiWiOn Expires October T tP23 = °
Co+rrmissror=No. :Q ��,+� Commiss:on 1o. - !Seal'
co
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETAT:ON SEA TURTLE MANGROVE I�
COUNTER REVsEbV REVIEW REVIEW RE?1'-t" REV Et;'% P,E`' E1v
DATE ------- - - ----------
RECEIVED
DATE
COMPLETED
Rev. 217/19 ..