HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 /01 /21
• D
WZ
Planning and Development Services
Building and Code Regulation Division
Permit Number:
Building Permit Application
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 Piero. FL 34945
Property Tax ID #: 3111-122-0015-0003 Lot No.
Site Plan Name: RIM DITCH Block No.
Project Name: RIM DITCH
DETAILED DESCRIPTION OF WORK: Ground Work
REMOVE (1) CABINET. (11 GENERATOR (1) TANK INSTALL (11 GENERATOR (11 TANK (1) RACK (1) POWER PLANT
"ALL ANTENNA EQUIPMENT WILL BE STEALTHINEUTRAL COLORS`
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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 ono
—Gas Piping
Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name American Tower Corporation
Name: Pavel Redko
Address: 10 Presidential Way
Company: Advanced CommunjotigIna 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(cDtepgrouo net
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail kristee ZDadvancedcommtech net
State or County License CGC1521987
u value u, conscruc❑on is vw or more, a ntcvnutu Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: as I
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
Name: Indrio Land Holdings LLC
Address: 7900 Glades RD Ste 402
City: Boca Raton
Zip: 33434 Phone
BONDING COMPANY: X Not Applicable
Name: _
Address:
City:
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 attornev before commencine work or recordine vour Notice of Commencement.
Signature of Owe�� acfor as Agent for Owner
STATE OF FLORIDA��� (� r
COUNTY OF ii��
Sworn or affirmed) and subscribed before me of Physical Presence or _ Online Notarization
this_ ayof hn-ynalh�linn,-20� by
J'CiU,ic O 1(�C� kp -
Name of person making statement.
Personally Known OR Pr uced I ification�_
Type of Identification Produced
(Signature of Notary rublic- State of Florida)
Commission No. 444 059z O (Seal)
4p Notary Pudio Slag or Floc
Kristee Nelson
tcommiaaio� NH a59433
Pima 11/02/1024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/ZU/Z1