HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/01/21 Permit Number:
O
p , U> L Building Permit Application
Planning and Development Services V
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 13698 Indrio Road Fort Pierce, FL 34945
Property Tax ID#: 1201-111-QQ02-000-5 Lot No.
Site Plan Name: STRAZULLA Block No.
Project Name:_ IRAZULLA
DETAILED DESCRIPTION OF WORK:TOWer work
REMOVE (3)ANTENNA(s)_ **ALL ANTENNA EQUIPMENT WILL BE STEALTH/NEUTRAL COLORS'"
INSTALL (9)ANTENNA(s), (6) RRH(s) (3) OVP(s) AND (2) HYBRID CABLE(s)
EXISTING (6)ANTENNA(s), AND N 2) 1 5/8" COAX CABLE(s) TO REMAIN„ _
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: Sq. Ft.of First Floor:
Cost of Construction:$ _15,n00 Utilities: —Sewer —Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name American Tower Corporation Name: Pavel Radko
Address: 10 Presidential Way „ Company: Advanced Communications Technoloay
City:_ Woburn State: MA Address: 15188 Park of Commerce Blvd, Suite 11
Zip Code: Q1801 Fax: City: Jupiter State: FL
Phone No. 404-618-4501 E- Zip Code: 33478 Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail kri V n mm h n
et
from the Owner listed above) State or County License CGC1521987
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: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: X Not Applicable
Name: Indrio Land Holdings LLC Name:
Address:_7900 Glades RD Ste 402 Address:
City: Boca Raton City:
Zip: 33434 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,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.
Signature of n ntractor as Agent for Owner
STATE OF FL RIDA7 � - r
COUNTY OF 11�" c�^t
Sworn to(or affir ed)and subscribed before me of Physical Presence or_Online Notarization
this day of ,� �nr20 2 !by
of fawLr uW6
Name of person making statement.
Personally Known OR ProNced identif ation �(
Type of Identification Produ
(Signature I
Notary Public-State of Florida)
CommissionNo.� N-0-Z-r083 (Seal) �'""4y Rristeetary OYosuleolFionaa
Kristee Nelson
+�r • Mr Commission HH 059433
eta�,d� Expires 11/0712H_
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21