HomeMy WebLinkAboutBuilding permit applicationAil APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04.22.202i
Permit Number•
ti
c Building Permit Application
Planning and Devetopment Servkes
Ruttdngand Code Regulation Division Commercial XX Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 4624578
PERMIT APPLICATION FOR;
PROPOSED IMPROVEMENT LOCATION:
Address: 6375 S US HIGHWAY 1
Property Tax ID #: 3415-501-0021-000-4
Site Plan Name:
Project Name: T-mobile A2P0305M
DETAILED DESCRIPTION OF WORK:
Modify existing telecommunicatins equipment
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Lot No.
Bloek No%
_,Mechanical _Gas Tank _Gas Piping . Shutters � Windows/Doors � Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 12,000.00
O
WNER/LESSEE:
NameFPt;<L
Address:700 Universe Bivd
City% Juno Beach State%
Zip Code: 33408 Fax:
Phone No, 9544444822
E-Mail: bart,simon@towerquest,com
Sq. Ft. of First Floor:
_
Utilities: _Sewer _Septic
Fill in fee simple Title Holder on next page If different
from
the Owner listed above)
CONTRACTOR:
Name:Steven Nichols
Buildin8 Height:
Company: Ericsson, Inc
Address:6300 Legacy Drive
City: Plano State:TX
Zip Code: 35024 Fax:
Phone No 352-446A241
E-Mail steve.nichols@ericsson,com
State or County License CGC1 518237
value of construction is 2500 or more, a RECORDED Notice of Comm
tf encement is required.
If value of HAVC is $7,500 or mare, a RECORDED Notice o4 Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name•srnvE ary
Address: css ®WAIM oORW DOM
City: &MVVM State% AL
Zip: WA4 Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address;
city:
Zip: Phone.•
MORTGAGE COMPANY: x Not Applicable
Name.•
Address;
City: State•
Phone.•
BONDING COMPANY; � Not Applicable
Name.•
Address%
city:
Phone
OWNER/ CONTRACTOR AFFIDVIT; Application is hereby made to obtain a permit todo the work and installation as indicated,
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 h1aermit will authorize the ermit holder to build the subject structure
which is in contlict with any applicable Home Owners Association rules, bylaws gran covenants that may, restrict or prohibit such
ed
structure, Please consult with your Home Owners Association and review your deFor any restrictions which may apply.
Inconsideration of the granting of this requested permit, I do hereby agree that I will, in all respecter 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,
accessary structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
G TO OWNER* Your failure to Record a Notice of Commencement may result in paying twice for
�vements to your property, A Notice of Commencement st be recorded in the public records of St.
County and posted on the jobsite before the first inspe ti . If you intend to obtain financing, consult
Winder or an attorney before commencinR work or record vour Notice of Commencement.
Signature of
STATE OF FLO
COUNTY OF
S orn to (or affirmed)
P ystcal Pre enc
this !fgL� day of jAZ
j f-t
as Agent for Owner
subscribed before me of
• MRKiA S��o i
•^�MMissloN �.; L
Name of person makidg state�ient;•"��`r�Q�G"""K 70 Ate'•
Personally Known 7' (fit jduced IQenWicatton e
fi ti Type of Idention = '. oG 986614 * i
Produced6'0 '
p ed thN `e�5 • Q
(Signature of Nc tar ublic '�MIj i iitttt\\\
Commission No. (Seal)
REVIEWS
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STATE OF�LOIi
COUNTY OF �r
Sworn to (or affirmed) and subscribed before me of
� Physical Presence or Online N tarization
this 22 day of Am , 202J by
Sta�� Nienalg
Name of person makir� statement.
Personally Known _ OR Produced identification xx
Type of identification �
Produced A D
(Signature o t, i161iciSt 11 aI .i i
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