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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � ©�— 0 Date: 1 ermit Number: Fl� SCANNED Building Permit Application BY Planning and Development Services St. Lucie County Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential PERMIT APPLICATION FOR: Alteration E, PROPOSED IMPROVEMENT LOCATION: Address: 9650 South Ocean Drive, Jensen Beach FL 34957 Legal Description: Property Tax ID #: 4502-610-0000-0006 Lot No. Site Plan Name: Princess Block No. Project Name: A2P0018B Princess Setbacks Front Back: Right Side: left Side:. DETAILED DESCRIPTION OF WORK., ' install of three antenna and three radios CONSTRUCTION INFORMATION: rtiona wor to je�e orme un ert ispermit—c ec a appy: ❑Gas []Windows/Doors 0HVAC Gas Tank Piping _Shutters En 0 RJElectric Plumbing 11 Sprinklers Generator Roof Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $ 13,000.00 Utilities: Sewer 0 Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Leasehold - T-Mobile South LLC Name: Daniel Ault Address: 1300 Concord Terrace, Suite 200 Company: Glotel Inc. Sunrise State: F� Address: 3060 Orange Grove Trial City: Zip Code:33323 Fax: City: Naples State:FL Zip Code: 34120 Fax: Phone No. Phone No.239-776-5884 E-Mail: Fill in fee simple Title Holder on next page ( if different E-Mail: danault@olinwaynecompanies.com from the Owner listed above) State or County License: CGC1522761 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. V SU PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: celcapTelecom Name: Add ress:3400 Lakeside ome Address: City: Kromer, State: FL City: State: Zip:3302r Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: PdmmnConmminiumAssoriadonofHWshinsonIsland Inc. Name: Address: 96sosoath ocean Ddve Address: City: Jensen Beach, FL City: Zip: Phone: Zip:34957 Phone: 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 anyfor any restrichtions which ay applyhibit such land reviebylaws with your HomHome strucctture. Please consult Owners Association your deed 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 WA NG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for impro ents to your property. A Notice of Commencement must be recorded and posted on the jobsite before t first inspection. If you intend to obtain financing, consult with lender or an attorney before comment work or recording our Notice of Commencement Signature of Owner/ A nt ssee Signatur of Cont actor/License Holder STATE OF FLORIDA STATE OF FLORfoLA9�vr�' COUNTY OF A COUNTY OF % The for instrument was acknowledged before me The forgoing instrument was acknowledged before me 20 x' by this � day of 1-2 (J 20 by this � y of JM q / (Name of person acknowledging (Name of person ack g) { •, v 0 Notary f F1' ? y �i (Signature of blic-State oo[ (Signatu of Notary Public- S of Flo 1� D !/ 1$' 2 Personally Known OR Produced Identificatio P_T• Personally Known OR Produced Ide*Q i- # Type of Identification Produced 30 —60 — 3 m Type of Identification Produced m %NEE8B3717 c amo Z c C£ 3 `/ 7� Commission No.�E8a�6S (Seal) S A D Commission No. �� f��•e�� U /rrgI11111HU\ Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S LE REVIEW MREV EWVE REVIEW REVIEW RE EW DATE COMPLETE INITIALS