HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 /01 /21
Permit Number:
o.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial V 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: 28000 Okeechobee Road Fort Pier P FL 34945
Property Tax ID #: 3111-122-0015-0003 Lot No.
Site Plan Name: RIM DITCH Block No.
Project Name: RIM DI _H
DETAILED DESCRIPTION OF WORK: Tower work
REMOVE (3) ANTENNAS INSTALL (9) ANTENNAS
""ALL ANTENNA EQUIPMENT WILL BE STEALTH/NEUTRAL COLORS`
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 15,000
—Gas Piping
_ Sprinklers
Shutters _ Windows/Doors Pond
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name American Tower Corporation
Name: Pavel Redko
Address: 10 Presidential Way
_
Company: Advanced QommuniQa1!Qns Technology
City: Woburn State: MA
Zip Code: 01801 Fax:
Phone No. 404-618-4501 E-
Address: 15188 Park of Commerce Blvd, Suite 11
City: Jupiter State: FL
Zip Code: 33478 Fax:
Phone No 561-771-6677
Mail: bdurham(a)tepgroup net
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail kristee(a)advancedcommtech net
State or County License_ CGC1521987
-�•••� �• ��• ��• ��• ..� ... �.., a nLuunucu ivunce or 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
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: Indrio Land Holdings LLC
Address: 7900 Glades RD Ste 402
City: Boca Raton
Zip: 33434 Phone:
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY: X Not Applicable
Name:
Address:
City:
Zip: Phone:
vwrrvcrc/ wry I rwu UK Arrruvl I: 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 grantin8 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 ait6rhPAcIaefnre rnmmPnrina wnrh nr rornr'ling ,n..r nln+i a , ; r,,.. _
Signatu essee/Contractor as Agent for Owner
STATE OF FLORIDA"
COUNTY OF TT &r✓ h
Sworn to (or affirmed) and subscribed before me of _ Physical Presence or Online Notarization
_
this 2AUday-of�' , �t 1tgjFi'r . 20 ?�, by
-YatR .� YIXo�WU
Name of person making statement.
Personally Known OR Pr ced Identificytion
_
Type of Identification Produced r..twrGeJ
(Signature of Notary P blic- State of Florida
Commission No. }II'I 0 51IM3 (Seal) Kn PNehon �wFi�aaa
A
94 MY Commission HH Dsa933
q� expiros ll/02/202q
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