No preview available
HomeMy WebLinkAboutBuilding Permit Applicationq0 Ste/ All APPLICABLE INFO MUST BE COMPLETED FOR APPLIICCePN TO BE ACCEPTED �' L `©� �{ Date: Z— 21 ���e Permit Number: o I b � I DECEIVED c�l° Building Permit Application APR 9 71121 Planning and Development Services vgrmitting Department Building and Code Regulation Division Commercial X Residential St• LuC1z°unto 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR:BUILDING Address: fr Property Tax ID #: q I t! . So) • 0 ! !3 ' DGM7 Lot No. Site Plan Name: TMO EXCALIBUR PROJECT A2P0036B-870159 Block No. Project Name: i iprrRnni= PYRTM-. Fnl IIPMFNT ON TFLFCOM CELL -SITE New Electrical Meter Second Electrical Meter Additional work to be performed under this permit —check all that apply: _Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond _ Electric _ Plumbing _ Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ Lf3,a ® O _ Generator _ Roof Pitch Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: t4.J ♦Fk4T •n..r.7c .K �} F .3j�t+t w, c: apt, r£r..<k OU1%I�R/LE'S5EE� re�,.i$!'i; $�1, "�£'._ CO s_ '`Y'4n�,b'4+i*'Kt�'x.+n..k+,, :.ivY`+"+`wiv k s *w i +5 d_.,�!e..• ^s ,• a,�,o,[.{ Name CROWN CASTLE Name: STEVE NICHOLS Address: 6420 CONGRESS AVE SUITE 2000 Company: ERICSSON INC City: BOCA RATON State: _ Address: 6300 LEGACY DRIVE Zip Code: 33487 Fax: City: PLANO State: TX Phone No. 786-901-0118 Zip Code: 75024 Fax: E-Mail: ANGEL.RIVERA@CROWNCASTLE.COM Phone No 352-446-1241 Fill in fee simple Title Holder on next page (if different E-Mail SFLPERMITS@CROWNCASTLE.COM from the Owner listed above) State or County License CGC1518237 If value of construction is 2500 or more, a RECORDED Notice or Lommencememi is requireu. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. ;- X w-y,�ip e +?,=F : '' •qM a%{?t 4t 'k'*FAisG""3�`i'iwA SUPPLEMENTRLCONSTRUCTION=LI�ENW�fNfORMATO;N:: 2x�a7 c^� - .. _. _ DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: 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 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 paying twice for improvements to your property. A Notice of Commencement must be recorded in the public records of St. Lucie County and on the jobsite before the first inspection. If you intend to obtain financing, consult ieiith lonrlor nr nrk attnrnov afnra rnmmanrina wnrk nr rPrnrrlinL vnur Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Sigfgkreof Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF DADE COUNTY OF DADE Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of x Physical Presence or Online Notarization x Physical Presence or Online Notarization this 10 day of APRIL this 10 day of APRIL .Is�'� Notary Public State of Florida r Rivera #a Pu Notary Public State of Florida DANIELLA BONILLA Angel STEVE NICHOLS a4 e , eel Rivera Name of person maki s ntmy on OF w Commisxpires 1012412021 Name of person makin t I9t. Expires 10/24/2021 Personally Known x OR Produced Identification Personally Known x P o' uce I entificntion Type of Identification Type of Identification Produced Produced (Signature of Notary Public- State of Florida) (Signature of Notary P li - f r' Commission #V °oe Notary Public State �� Notary Public Stat of e Commission No. '� ivera rSea Ives commission GG 121794 • �' 412021 My Commission GG 121794 Expires 10124/2021 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE. COMPLETED Kev. 5/ b/ LU