HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)ATC 412253 Dish MIMIA00067A Collocation
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Ova
O'
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 CBDG Funding
PERMIT APPLICATION FOR: ATC 412253 - Dish MIMIA00067A - Collocation
PROPOSED IMPROVEMENT LOCATION: I
Address: 4690 EMERSON AVE, Fort Pierce, FL 34951
Property Tax ID #: 1314-323-0001-000-6
Site Plan Name: ATC 412253 - Dish MIMIA00067A - Collocation
Project Name: ATC 412253 - Dish MIMIA00067A - Collocation
Lot No.
Block No.
(1) proposed ice bridge, (1) proposed PPC cabinet, (1) proposed equipment cabinet, (1) proposed power conduit, (1) proposed TELCI
rnnrdnit (1)TF.ILD-Fiber box (1) prn:nnserdGPSunit (1) prop (1)proposed Fiber NTT) (1) proposedmeterand
meter socket. See plans for full details.
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
[Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ $25,000 Utilities: —Sewer _Septic
Building Height:
Pond
Pitch
OWNS
CONTRACTOR:
Name Dish Wireless, LLC
Name:
Address: 9601 South Meridian Blvd.
Company: BTO Construction, INC.
City: Englewood State: CO
Address: 1718 KENNEDY POINT, #1008
Zip Code: 80112 Fax:
City: Oviedo State: FL
Phone No. E-
Zip Code: 32765 Fax:
Mail:
Phone No 407-622-1077
E-Mail
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
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:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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, 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.
ature of caner/ Lessee/Con ctor as Agent for Owner
STATE OF FLARH)A Alabdw
COUNTY OF Secrson
Swefa-to4ef--affirmedY'a'nd subscribed before me of X Physical Presence or Online Notarization
this 15'r-day of S�e.r 20Z1 by
Bri an SuiI i vAvx 3r
Name of person making statement.
Personally Known —V OR" -
Type oUdenbficaUop,��
(Signature of Notary Public- State A►abama
Commission No. (Seal) KATIE LEANNE KYLE My Commission l±x� ;
Notary Public ..
Alabama State at Large August 13, 2025
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