HomeMy WebLinkAboutA2P0038B - Ground ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
o L 1j��'.IcIF L`1`)L/
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial �_ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Antenna Tower
PROPOSED IMPROVEMENT LOCATION:
Address: 375 E Midway Road Fort Pierce, FL 34982
Property Tax ID #: 3403-502-0055-020-3 Lot No. 34
Site Plan Name: Block No.
Project Name: A2P0038B - Excalibur Project
DETAILED DESCRIPTION OF WORK:
Removing and replacing antennas and equipment at already exsisting T-Mobile's wireless facility.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
X_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 5,000.00 Utilities: -Sewer —Septic Building Height: 300'
OWNER/LESSEE:
CONTRACTOR:
Name T-Mobile South LLC
Address: 1300 Concord Terrace Suite 200
City: Sunrise State: FI
Zip Code: 33323 Fax: N/A
Phone No. 561-226-9287
Name: Frank Kisel
Company: Ericsson, Inc.
Address: 6300 Legacy Dr
City: Plano State: TX
Zip Code: 75024 Fax:
Phone No 303-829-4100
E-Mail:ccastro(nsbasite.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Frank kisPlaericsson com
State or County License EC13009490
It value of construction is 2500 or more, a RECORDED Notice of 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:
Name: Matt Abbey
_ Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
Address: 14471 Miramar Parkway, suite 202
City: Miramar
Zip: 33027 Phone 954-744-1538
State: _FI—
City: State:
Zip: Phone;
FEE SIMPLE TITLE HOLDER:
Name: SBA Towers II LLC
Not Applicable
BONDING COMPANY: xNot Applicable
Name:
Address: 8051 Conoress Avenue
City: Boca Raton
Zip: 334R7 Phone:_
561-220-9267
Address:
City:
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. Lucic 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 posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
),/. e
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF ft-E� CCUTAEA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this J�_ day of /yti✓��-- 20� by
Name of person making statement.
Personally Known L—OR Produced Identification
Type of Identification Produced
C__
(Signature
Commission No
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
otary Public- State off
(Seal)
FRONT I ZONING
COUNTER I REVIEW
JUSTIN NAGAI
NOTARY PUBLIC - STATE OF COLORADO
NOTARY ID 20184039278
MY COMMISSION EXPIRES OCT 4, 2022
SUPERVISOR I PLANS VEGETATION SEATURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW