HomeMy WebLinkAboutBuilding Permit ApplicationA2P0105A 5800245 Exc- "x
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q G�
Date: 04.15.2021 Permit Number:
Building Permit Application All
Planning and Development Services AN 2.9 2
Building and Code Regulation Division pspartment
2300 Virginia Avenue, Fort Pierce FL 34982 p°rSt. Lu ie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: Alteration
PROPOSED IMPROVEMENT LOCATION:
Address: 5041 ST. LUCIE BLVD. FT. PIERCE, FL. 34996
Legal Description: 3134 40 W 342.25 FT OF E 684.5 FT OF S 836 FT OF NE
Property Tax ID #: 1431-211-0001-000-2 Lot No.
Site Pia Name: Block No.
Project Name: TMO EXCALIBUR-A2P0105A
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
EQUIPMENT UPGRADE TO EXISTING CELL -TOWER Qemc)�e (-eOQCe
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit c ec a apply:
11HVAC Gas Tank FGas Piping Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �{3, a 0 0 Utilities:In Sewer O Septic Building Height:
OW N ERAESSEE
CONTRACTOR:
Name T-MOBILE/Crown Castle
Name: STEVEN NICHOLS
Address: 6420 Congress Ave
Company:. ERICSSON INC
City: Boca Raton State: FL
Address: 6300 LEGACY DRIVE
Zip Code: 33487 Fax:
City: PLANO State: TX
Phone No. 561-544-4965
Zip Code: 75024 Fax:
E-Mail: SFLPermits@crowncastle.com
Phone No. 352-446-1241
E-Mail: steve.nichols@edcsson.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CGC1518237 .
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
.SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: CHARLES H FOX DAVID A HOINES
Name:
Address: 3081 E COMMERICAL BLVD. #200
Address:
City: FORT LAUDERDALE
City:
Zip: Phone:
Zip:33027 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 m st be recorded and posted on the jobsite
efore the first inspection. If you intend to obtain financing, cQn ult with lender or an attorney before
commitning work or recording vour Notice of Commencem
_ Signature of Owner/
STATE OF FLORIDA
COUNTY OF r3aAc
The forgoing instru ent was acknowledged before me
this K* day of 9,, , t 20 ? 1 by
Z>A"h, 2 114 &,! k'G
(Name of person acknowledging)
(Signature of NoU7011
State of Florida )
Personally Known Produced Identification
Type of Identification Produced_
Commission No.
Revised 07/15/2014
NotaryPugllc_st@te of Florida
Angel Riv a
My Commission GG 121794
Expires 10/24/2021
Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Lake
The forgoing instrument was acknowledge efore me
A' this 'Sth day of "' 20 by
Steven Nichols
(Name of person acknowledging)
wx�t
(Sigr#ure of Notary Public- State of Florida )
Personally Known OR Produced Identification xx
Type of Identification Produced Fi DL
Commission No.
MY COMMISSION # GG 274502
Bonded ThruNotary Public Underwriters
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