HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONV Z IV 69? 0-7
ALL APPLICABLE INFO M�ST BE COr�KrET FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie County RECEIVED
Building Permit Application JUN 2 9 2015
Planning and Development Services
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: Other
CAT, N.'
_PROPOSED IMPROVEMENT LO 10
Address: 6425 Russakis Road, Fort Pierce 34951
Legal Description: 3 34 39 N 1/2 OF S 1/2 OF S 1/2 OF SE 1/40F NW 1/4-LESS E 70 FT FOR CANAL- (4.83 AC) (OR 168-657;
PropertyTaxlD#: 1303-243-0001-000-7
Site Plan Name:
Project Name: Verizon 68887 Crown Beth's Song
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
I'DETAILEO'DIR-SCRIPTION OF WORK: I � 'I
Installation of new wireless equipment
11HVAC L]Gas Tank
ZElectric 1:1 Plumbing
antennas for enhanced wireless dommuni�ation service.
perm it — cllecK all apply;
Gas Fir - In Shutters OWindows/Doors
Sprinklers F/]Generator 11 Roof
Total Sq. Ft of Construction: 360 Sq'. Ft. of First Floor:
Cost of Construction: $ 65,000 :110j= = E—:6jRQes: 0 Sewer D Septic Building Height:
OWNtR/LESSEE._
cbNTR-AC_T7O_'R--:'-
Name Verizon Wireless Personal communications LP
Name: e. Lv
Address: 777 Yamato Road Suite 600
Company: if 0 ll-�' S4r VC� 5 C.
City: Boca Raton State: FL
Zip Code: 33431 Fax:
Phone No. 561-995-5723
r
Address: 14 q q 0 �E 5 3 _1
City: OCC4 I ci State:_a
Zip Code: -3 4 4 9 0 Fax:Y5a-(.0aP,-40z
Phone No. _IJ5 19L_ (S 9.a._ 'YlL 01�5
E-Mail: Mark.Baesch2@VerizonWireless.com (Real Estate Manager)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:6;R\�A & 0,3 or —
State or County Licenseck2c-dou \WAO.
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
CONSTRUCTIOWLIENIAW INFORMATION:
DESIGNER/ENGINEER: x NotApplicable
Name: Waypoint Engineering and Equipment U-C
MORTGAGE COMPANY: X NotApplicable
Name:
Address: 820 W Indiantow Road
Address:
city: - Jupiter State: - FL
Zip: 33458 Phone: (561)252-1220
City: State:
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: Russakisinves�entsi-I-C
BONDING COMPANY: X NotApplicable
Name:
Address: 8801 Indrio Rd
Address:
City: Fort Pierce
City:
Zip: 34951-1615 Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conlylict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 your Notice of Commencement.
of Owner/ Lessee/Agent
STATE OF FLQRU*
COUNTYOF k� zcc�
The forgoing instrument was acknowledged before me
this�Or'lldayof X�v� 20 V"___J)y
jA 1 - a 74!Q' = s
Signature of Contracfgr/License Holder
STATE OF
COUNTY OF
The forgoing instrument was acknowledged before me
thisIL14—dayof '�� 20 La— by
:::�n Q� M; Q'6j�� A - Po I, Wo 1k)
(Name of person acknowledging (Name of person acknowledging) Q
(Signature
Personally Known OR Produced Identification
Type of Identification Prbduced_
Commission
Revised 07
�L%s� �61k'TK )
(Signature of No `() Publiotate of Florida)
Personally K�own �C OR Produced Identification
Type of Identificati-on Produced
Commission
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