HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
CIL
c: E C E•,; c L", k ---- 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
PERMIT APPLICATION FOR: Antenna Tower
PROPOSED IMPROVEMENT LOCATION:
Address: 1401 Swain Road Fort Pierce FL 34947
Property Tax ID #: 2418-242-0001-000-0 Lot No.
Site Plan Name: _ Block No.
Project Name: A2P0044G - Excalibur Project
DETAILED DESCRIPTION OF WORK: I
Removing and replacing antennas and equipment at already exsistinq 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:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
(Affidavit required)
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 5,000.00
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height: 450'
OWNER/LESSEE:
CONTRACTOR:
Name T-Mobile South LLC
Name: Frank Klsel
Address: 1300 Concord Terrace Suite 200
Company: Ericsson Inc.
City: Sunrise State: FI
Zip Code: 33323 Fax: N/A
Phone No. 561-226-9287
E-Mail: ccastroQsbasite com
Address: 6300 Legacy Dr
City: Plano State: TX
Zip Code: 75024 Fax:
Phone No 303-829-4100
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Frank k'sel anericGson.rom
State or County License EC13009490
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 -
DESIGN ER/ENGIN EER: _ Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name: Matt Abbey
Name:
Address: 14471 Miramar Parkway. Suite 202
Address:
City: Miramar State: Fl
City: State:
Zip: 33027 Phone 954-744-1538
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: XNot Applicable
Name: Juan and Carol Alas
Name:
Address: 258 SW Reynolds Avenue
Address:
City: Port St Lucie
City:
Zip: 349fi3 Phone: 561- 226-9287
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-residentlal 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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLeWDA C4L49A4b
COUNTY OF ,00.4 J i c
Sworn to (or affirmed) and scribed before me of �hysical Presence or Online Notarization
this _3C day of C �7J 20'U1 by
r I�A) r- t SbL
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
l E
(Signature of Notary Public- StateofFlocidaa (:�O"ILA4
Commission No. ZDU3RG3 (Seal) KEVIN T SHIGIO
NOTARY PUBLIC - STATE OF COLORADO
NOTARY ID 20024039063
MY COMMISSION EXPIRES DEC 28, 2022
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