HomeMy WebLinkAboutBuilding Permit Application AEI APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Da[{t��e: 08 23 2021 Permit Number:
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° -� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: Cell Tower - Ground Work
PROPOSED IMPROVEMENT LOCATION: r'oo'ficationo?exis-.jr)gequiprnentonanexiglifigurrnanr)ecI
Address: 2651 MINUTE MAID RD Ft, Pierce, FL 34945
PropertyTax ID#: 1231-111-0003-000-5 Lot No.
Site Plan Name: T-Mobile A2P0049A Ground Work Block No.
Project Name: 8137001 665705 1566925 1 A2130049A
DETAILED DESCRIPTION OF WORK:
Adding(3)new hybrid cables.Removing(1)coax lines.Ground Notes:Ancillary Equipment(Ericsson) B160 and Enclosure 6160.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this 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: NIA Sq. Ft. of First Floor. N/A
Cost of Construction: $ 5,000 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name T-Mobile Name: Steve Nichols
Address: 1300 Concord Terrace, Suite, 200 Company: Ericsson, Inc
City: Sunrise State: FL Address:_ 6100 I Pgary nrivP
Zip Code: 33323 Fax: City: Plano State: TX
Phone No, 813-519-9320 E- Zip Code: 75024 Fax:
Mail:bcam beil trunorthe.com Phone No 352-446-1241
Fill in fee simple Title Holder on next page (if different E-Mail steve.nichols@ericsson.com
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.
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: 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: J & E Hale Enterprises Inc _ _ Name:
Address: PO Box_ 8 Address:
City: Tetonia City:
Zip: 83452 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 conflicts with anY applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure, Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, l 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 O OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improv ments to your property. A Notice of Commencement must be recorded in the public records of St.
Lu dunty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wif der or an attorney before commencing work or recording our Notice of Commencement.
Signatu 0
of Owner/Lessee/mantra r as Agent for Owner
STATE OF FLORIDA
COUNTY OF SeEM II,IPi_5_;z _
Sworn to(or affirmed)and subscribed before me of _-Zr`_Physical Presence or Online Notarization
this ZSdayof 95�IA6r 20-ZLby
S'Te vv /tf t&4c>cry
Name of person making statement. ,bhp
Notary Public Sta,e of Fiaida
Evan 08wd Wong
Personally Known OR P oduced Identification L-'p avid o�sso3�aType of Identification Produce MyGomExp res 47101 r1023 A
(Signature of Notary Plig Ic- tote of Florida)
Commission No.A-&-tS03ct+{seao
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW 3 REVIEW REVIEW REVIEW
DATE
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RECEIVED
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