HomeMy WebLinkAboutBuilding ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
I Liu
O U � �
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: bfUl URANGE AVE
Property Tax ID p: 2311-320-0000-000-0
Lot No.
Site Plan Name:
Block No.
Project Name: Telecom improvement 8138121A2P0238S T-Mobile
DETAILED DESCRIPTION OF WORK:
T-MOBILE ANTENNA AND GROUND EQUIPMENT REPLACEMENT ON EXISTING CELL TOWER SITE
CROWN 813812 T-MO 2130 38
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: 100 Sq. Ft. of First Floor:
Cost of Construction: $ 20.000 Utilities: _Sewer —Septic Building Height: 250' TI
Name CROWN CASTLE SOUTH, LLC
Address: 2000 CORPORATE DRIVE
City: CANONSBURG State: PA
Zip Code: 15317 Fax:
Phone No. 954-263-8764
E-Mail: kesha.dejesusr@towerquest.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: _STEVE NICHOLS
Company: ERICSSON, INC
Address: 6300 LEGACY DRIVE
City: PLANO State: TX
Zip Code: 75024 Fax:
Phone No 352-446-1241
E-Mail steve.nicholsdedcssoncom
State or County License CGC1518237
a v iue or construction is ZSGO or more, a RECORDED Notice of Commencement is regt
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
Name: KIMLEY-HORN&ASSOCIATES
MORTGAGE COMPANY:
Name:
V Not Applicable
Address: 1920 WEKIVA WAY
Address:
City: WESTPALMBEACH State: FL
Zip: 33411 Phone
City:
Zip: Phone:
State:_
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name: FLORIDA OAS TRANSMISSION CO
BONDING COMPANY:
Name:
V Not Applicable
Address: 2424 RIDGE ROAD
Address:
City ROCKWAll TX
City:
Zip: 75087 Phone:
Zip: Phone:
UWNLK/ LONTRACTOR 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 antl 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 wncurrency 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
_ga-'�e00 &'t1 ' 0 4
Signature of Owner/ Lessee Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SAINT LUCIE
Sworn to (or affirmed) and subscribed before me of V Physical Presence or _Online Notarization
this 5 dayof NOVEMBER 2021 by
1%me: etly 13p • �� et'nWl1 �'aC-ii4
Name of person makcng statement.
Y••.,i KESHA M DEJESUS
Personally Known �L_OR Produced Identification _ Notary Public -State of Florio
Type of Identification Produced = Commission a HH 83779
Commission No. (Seal)
REVIEWS COUNTER REVIEW SUPERVISOR
REVIEW I VEGETATION I SEEEVIIEW I MANGROVE