HomeMy WebLinkAboutBuilding permit Ground WOrk applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06.17.2021 Permit Number:
ST. LUCIE
COUNTY
F L O R I D
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772)4624553 Fax: (772) 462-1578
Commercial � Residential
PERMITAPPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 13698 INDRIO RD EXT
Property Tax ID #: 1201-111-0002-000.5
Site Plan Name:
ProjectName: T-mobileA2P0246S
DETAILED DESCRIPTION OF WORK:
lodify existing telecommunicatins equipment
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional
Lot No.
Block No.
work to he
performed underthis permit —check all
that apply:
_Mechanical
_Gas Tank
_Gas Piping
_Shutters _Windows/Doors _Pond
_ Electric
_ Plumbing
_Sprinklers
_ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq.
Ft. of First Floor:
Cost of Construction: $
12,000.00
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.954A44-2822
Address:6300 Legacy Drive
City: Plano State:TX
Zip Code: 35024 Fax:
Phone No 352-446-1241
E-Mail:bart.slmon@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 License CGC1 518237
Ir value or Cons[mafla0 6 [ODU or more, a RECORDED Notice of Commencement is regUlred.
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:sMw Engineering
Name:
Address: lse suelnes cenet,oMe
Address:
City: i inningham State:
City: State:
Zip:362+a Phone�sg-was
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.
1 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 conFllct with any dpplicable 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.
Inconsideration 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 , structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WA ING 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 attorney before commencing work or recQraing your Notice of Commencement.
Signature caner/ Lessee/Contractor as Agent for Owner
Signat o Contractor/License Holder
STATE OF RIDA
STATE OF FLORIDA
COUNTY OF R.+.
COUNTY OF ge
�y win to (or affir d) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Prese ce or. Online Notarization
xx Physical Presence or. Online Notarization
this day of 2020 by
this Inn day of June , 2020 by
QS��ts � 6
Steven Ni&ols
Name of person making stat ent.
Name of person making statement.
tp,y� ta11I�111t{
Personally Known % OR" 1� wlU j %n
Type of ldenti ation \����� PSION Fop• //��%
Produced �'•�
• gER 101?0 ip'•
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••
Personally Known OR Produced identification xx
ProduceType of ld Identification
(Signature of Notary Public-SY le%@ blY qa ASHLEY L, DAVIS
'111 a,, �YCDMMISSIDNNHH
Commission No. tttt�a I3 - 2neC?`(Boe ThRES:arynuary 20Me
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(signature o Notary P -XsweiffFlgLidaei _
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