HomeMy WebLinkAboutBuilding permit Tower Work applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06.17,2021
Permit Number:
Snro Wag
p Building Permit Application
Planning and Development services
Buildingand Code Regulation Division Commercial XX Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772) 462-1578
PERMITAPPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 13698 INDRIO RD EXl
Property Tax ID tk: 1201-111-0002-000.5
Site Plan Name:
Project Name: T-mobile A2P0246S
DETAILED DESCRIPTION OF WORK:
telecommunicatins ec
New Electrical Meter Second Electrical
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 12,000.00
_Generator
Lot No.
61ock No.
_Windows/Doors _Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Indrio Land Holdings LLC
Name:Steven Nichols
Address: 7900 Glades RD Ste 402
Company: Ericsson, Inc
City: Boca Raton State: _
Zip Code: 33434 Fax:
Phone No.954-444-2822
Address:6300 Legacy Drive
City: Piano State:TX
Zip Code:35024 Fax:
Phone No 352-446-1241
E-Mail: bart.simon@towerquest.com
Fill In fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail steve.nichols@ericsson.com
State or County LicenseCGC1518237
una scruiun rs uu coor more, a necuautu rvotice oT Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:'
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:smwenuinuedne
Name:
Address: +fie eumms come, v"
Address:
City: emmnenem State:
City: State:
Zip:35244 PhoneW0 252-e935
Zip: Phone:
FEE SIMPLE TITLEHOLDER: x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no work or installation has commenced prior to the Issuance of a permit.
St. Lucie Counttyy 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,
ac ssorystructures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WA NING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
i provements to your property. A Notice of Commencement must be recorded in the public records of St.
L ie County and posted on the jobsite before the first inspec ion. If you intend to obtain financing, consult
wi lender or an attornev before commencing work or recQrcling your Notice of Commencement.
Signature nor/ Lessee/Contractor as Agent for Owner
Signatu o Contractor/License Holder
STATE OF RIDA J
STATE OF FLORIDA
COUNTY OF Tu,N
COUNTY OF Lake
orn to (or affir d) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Prose ce or_Online Notarization
xx Physical Presence orOnlfne Notarization
this. day of 2020 by
this +ne day of June 2020 by
sloven Nichele
Name of person making stat ent.
Name of person making statement.
1 11 �III{
Personally Knownntil'i OR\( � al,
Personally Known OR Produced Identification xx
Type of ldentifcation �� pR,,....,H ij
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Type of identification
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o NotaryP e6f Flgpda/ _
(Signature of Notary Public- St ASHLEY L. DAVIS
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