HomeMy WebLinkAboutBuilding Permit Application- 7
ALL APPLICABLE INFO MUST BE COMP«!K_D FOR APPLICATION TO BE ACCEPTED
Date: t
�.�� ,� � R Permit Number:
Building Permit Application MAR 2 12017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Rhone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Alteration
PROPOSED IMPROVEMENT LOCATION:
Address: 9901 Range Line Road, Port St. Lucie 34987
Legal Description: Book 2675 / Page 66
Property Tax ID #: 4201-134-0003-010-5
Site Plan Name:
Project Name: Verizon Wireless Site# 68828 KEYS WI-FI SOUTH FLORIDA RECYCLES
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
At existing communication site, modification of 9 existing antennas reusing associated coaxial cable.
Also to install 6 diplexers and 3 BIAS-T units at antennas and 6 diplexers at grade.
CONSTRUCTION INFORMATION:
Adclitionalworl(tobeDertormedunder tispermit—check all apply:
11HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing []Sprinklers Generator 1:1 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 2-1 p 000
S Ft. of First Floor: _
Utilities:cn Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Verizon Wireless
Name: Anthony Ankersmit
Address:7701 Telecom Parkway
Company: UCI Construction Services, LLC
City: Tampa State: FL
Zip Code: 33637 Fax:
Phone No.
Address: 7103 East 6th Avenue
City: Tampa State: FL
Zip Code: 33619 Fax:
Phone No. 813-386-6202 - Debra Drury
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ddrury@ucics.net
State or County License: CGC1517870
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: "ugh Reilly/ CBVR Telecom Design Name:
Address:51131VIemadalHighway - Address:
City: Tampa State: FL City: State:
Zip: 33634 Phone; 770-853A233 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: x Not Applicable
Name: wcAor St. Lucie LLc
Address: 5002 Sw 41 st Blvd.
City: Gainesville, FL
Zip; 32608 Phone: _
Name: _
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement-
- Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
14 l
(Name of person acknowledging)
Signature
STATE OF FLORIDA
COUNTY OF H uLsBORourH
The forgoing instrument was acknowledged beflemey
this 74" day of mARcH 20 _ b
ANTHONY ANKERSMIT I i T
(Name of person acknowledging) I R .a
(Signature of Notary Public- State of Florida ) I (Signature of Notary Public- State of
Personally Known OR Produced Identification Personally Known x OR Produced Identifi s
Type of Identification Produced Type of Identification Produced '•;M 9
Commission No. (Seal) Commission No. FF973213 (Seal)
Revised 07/15/2014
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