HomeMy WebLinkAboutWINDRIOBRA351_813722_MIMIA00169A_551657_BPEPNOC(2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _______ _ Permit Number: _______ _
Crown -813722 Dish -MIMIA00169A App -551657
Planning and Development Services
Building and Code Regulation Division
Building Permit Application ✓ Commercial Residential -----------2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
CBDG Funding ___ _
PROPOSED IMPROVEMENT LOCATION:
Address: 12888 lndrio Rd.
P rop er ty T ax I D#:
Site Plan Name: W INDRIO BRA351
Lot No. ___ _
Block No. __ _
Project Name: _________________________________ _
I DETAILED DESCR[PTION OF WORK:
Co location
New Electrical Meter ____ Second Electrical Meter ______ (Affidavit required)
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
� Electric
Gas Tank
_Plumbing
_ Gas Piping
_ Sprinklers
Shutters _ Windows/Doors
Generator Roof ----
Pond
Pitch
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: _________ _
Cost of Construction:$ --------Utilities: _ Sewer _ Septic Building Height: ___ _
OWNER/LESSEE: CONTRACTOR:
Name Crown Castle Name: ----------------Address: 2000 Corporate Dr. Company: New Tech Construction Corp City: Canonsburg State: PA Address: 1579 Barber Road Zip Code: 15317 Fax:________ City: Sarasota State: FL Phone No. E-Zip Code:34240 Fax: ______ _ Mail: bjones@tepgroup.net Phone No (941)485-8988
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail dennis.lawler@ntctowers.comState or County License SCC131151517
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.
W INDRIO BRA351
1317-122-0025-000-2
10,000
49,000
on existing wireless tower
DESIGNER/ENGINEER: _ Not Applicable
Name : Stephen Ridge
Address: 5449 Bells Ferry
Name: ________________ _ Address: ______________ _ City: Acworth State: � City: ____________ State: Zip: 30102 Phone_6_7_8-4_6o_-_14_2_1 _____ _Zip: _____ Phone: _________ _
BONDING COMPANY: _ Not Applicable
Name: _______________ _
FEE SIMPLE TITLE HOLDER: _ Not Applicable Name:
A ddress: 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.
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 structur ewhich 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 O NER: Vo r failure to Record a Notice of Commencement may result in paying twice for improvem ts to you property. A Notice of Commencement must be recorded in the public records of St. Lucie Cou y and po ed on the jobsite before the first inspection. If you intend to obtain financing, consult with len or an at orne before commencin work or recordin our Notice of Commencement.
Sig')Y e of Owner/ Lessee/Contractor as Agent for Owner
sf ATE OF FLORIDACOUNTY OF ��
Sworn to (or affir
this 1.LL day of
nd subscribed before me of��:'.'.!:__, 2021. by
_L_ Physical Presence or Online Notarization
Personally Known __J_ OR Produced Identification
Type of Identification Produced _________ _
REVIEWS
DATE RECEIVED
DATE
D
FRONT COUNTER ZONING REVIEW
,,,, MORGAN TICHENO(:l
-� Notary Public-State of Flonda
•� Commission # GG 945507
"::-�'+' � My Commission Expires,,,,,,,11,,,,,, January 08, 2024
SUPERVISOR PLANS VEGETATION REVIEW REVIEW REVIEW SEA TURTLE REVIEW MANGROVE REVIEW
25/95 Indrio Road LLC
PO Box 540669
Lake Worth, Florida
33454
8 34 39 BEG AT W 1/4 COR OF SEC, RUN N 0 DEG 20 MIN 54 SEC E ON W SEC LI 360.33 FT TO PT ON SWLY R/W I-95, TH S 36 DEG 33
MIN09 SEC E ON SD R/W 3834.40 FT TOPT ON S SEC LI, TH S 89 DEG 40 MIN 28 SEC W 2302.98 FT TO SW COR OF SEC, TH N 0 DEG 21
MIN 35 SEC E 2699.37 FT TO POB-LESS CANAL R/W- (79.19 AC) (OR 3666-2413)
W INDRIO BRA351
1317-122-0025-000-2
25/95 Indrio Road LLC
PO Box 540669 Lake Worth, FL 33454
I Affidavit Crown -813722 Dish -MIMIA00169A App -551657 ST. LUCIE 0 K
Date _ - 16- 2021
1317-122-0025-000-2
12888 lndrio Rd.
Permi
I have r quested to install an additional electric service/meter at the above named property. By
• • •
I fully
off to t
his affidavit, I fully agree that the additional electrical service/meter does not allow for peration of a business venture or entity within the accessory structure enting or leasing any portion of the accessory structure onverting accessory structure into additional occupied or living space derstand that if the conditions of this affidavit is found in violation, power may be shut
building without notice.
Signature of Owner
STATE OF F ORIDA, COUNTY OF _X7...,__,_'4-_D_:'I--S_0-_•_'i�-\�-----
SWORN (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF X:
ONLINE O ORIZATION THIS rz.,,..'l-,A_o\_ DAY OF "'?)?-{)� \,_;1..,,_x
PHYSICAL PRESENCE OR ____ _
20 '2.,.1
NAME OF P RSON MAKING STATEMENT � ,e.__ ":,c.,,., c.� r;-,"-Y r'. «::,
PERSONA L KNOWN _A __ ,__ ___ OR PRODUCED IDENTIFICATION ________ _
NTIFICATION PRODUCED ---------------------
PLANNI & DEVELOPMENT SERVICES I BUILDING DIVISION
,• 2300 Vig ·a Avenue I Fort Pierce, FL 34982 \. (772) 467 -1553 � (772) 462 -1428 .. (772) 462 -1578 @www.stlucieco.gov