HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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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:Telecommunication
PROPOSED IMPROVEMENT LOCATION:
Address: 375 E Midway Rd
Property Tax ID f;: 3403-502-0055-020-3
Site Plan Name:
Project Name: MIMIA00768A Midway Road
Installation of Dish antennas and associated telecommunication equipment at an existing cell tower
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 30,000
Sq. Ft. of First Floor:
Lot No.
Block No.
_Windows/Doors _Pond
_ Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
:CONTRACTOR:
Name Dish Wireless
Name: Gustavo Dezzuto
Address: 8051 Congress Ave
Company: SBA Network Services LLC
City: Boca Raton State: _
Zip Code: 33487 Fax:
Phone No. 56619819904
Address:8051 Congress Ave
City: Boca Raton State: FL
Zip Code: 33487 Fax:
Phone No 561-981-7384
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail kfleurilus@sbasite.com
State or County License CGC1524899
If 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:
Not Applicable MORTGAGE COMPANY:_ Not Applicable
Name: TEP OPCO LlC/ Joshua H Carden Name:
Address: 325 Tryon Rd. Address:
City: Raleigh State: NC City: State:
Zip: 27603 Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name: sBATowars B u c
Address: 3051 Congress Ave
City: Boca Raton
Zip: 33487 Phone: 5619819904
BONDING COMPANY: '_Not Applicable
Address:
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 co urrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and ac sory uses to another nitainEfinancing,
esral use
WARNING TO OWNER: Your failure to Record a Notice of Commence nt may result in payor
improvements to your property. A Notice of Commencement st be recorded in tpurecords of St.
Lucie County and posted on the jobsite before the first inspecti n. If you intend tc 99 consult
with lender or an attorney before commencing work or recordi gLyq;ur, Noticg of gbmmencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 9
COUNTY OF 'PAIrr1 �v
Sworn to (or affirmed) and subscribed before me of
V Phyysi�cal Presenc or Online Notarization
this J " ay of ,Rpkm u% . 2024.by
7owt f�.l��n�rw�
Name of person making statement.
Personally Known / OR Produced Identification
Type of Identification
EXPIRES: July 10, 2022
-Bonded-�Ytfti-AaFan Not�i¢aq
Signature
STATE OF FLORIDA
Sworn to (or affirmed) and subscribed before me of
✓ Physical Presen a or Online Notarization
this day of 202�by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
EXPIRES: Jul 90, 202�ea1)
Sonde ihru aron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/t3/2u
Rev 5/t3/2u