HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE Con,;`, fTED FOR APPLICATION TO BE ACCEPTEI'i"_"
Date: y ' I Number: /�O % � 9151
SCANNEDPermit
BY
St. Luce County RECEOVED
Building Permit Application SEP 3 0 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 Residential
PERMIT APPLICATION FOR: Building
PROPOSED IMPROVEMENT LOCATION:
Address: 375 E. Midway Road Fort Pierce, FL 34982
Legal Description: White City S/d 03-36-40 N 261 FTOF Lot 34-Less E 10oFT and Less RD RIW- (1.31 AC) (Map 34/03S)
OR 3014-2382)
Property Tax ID #: 3403-502-0055-020-3 Lot No. 34
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove and/or replace antennas and equipment at already existi g facility.
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CONSTRUCTION INFORMATION:
itiona wor to e e orme un er this permit— c ec a apply:
11HVAC �GasTank ❑Gas Piping ❑Windows/Doors
_Shutters
❑Electric 0 Plumbing Sprinklers E] Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Height:
——Cost-of_Constructlon_$ 12,000.00 Utilities:SewerE]Septic Building
OWNER/LESSEE:
CONTRACTOR:
Name T-Mobile South LLC Name: Dan Ault
Address: Concord Terrace Suite 200 Company: Glotel, Inc
City: Sunrise State: FL Address: 3060 Orange Grove Trail
Zip Code: 33323 Fax: N/A City: Naples State: FL
Phone No.954-514-8020 Zip Code: 34120 Fax: NIA
E-Mail: Denise.Correa6@T-Mobile.com Phone No. 239-776-5884
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
is $2500 or more, a RECORDED Notice of Commencement is required.
If value of construction
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SUPPLEMENTAL
LIEN LAW INFORMATION:
DESIGNERIENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: CaitropTelecom Name:
Address: 3400 Lakeside Drive Suite 525 Address:
City: Miramar State: FL City: State:
Zip: 33027 Phone: B50-b74-787o Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable I BONDING COMPANY: x Not Applicable
Name: SBATmersnLLC
Ad d ress: 8051 Congress Avenue %Tax Dept
City: Boca Raton
Zip: Fiodda Phone: NIA
Name: _
Address:
Zip: 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
which is in conflict 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 tructures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING\ O OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvemeq to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the fits 'nspection. If you intend to obtain financing, consult with lender or an attorney before
rommencine a10 or recording Your Notice of Commencement
_ Signature of owner/
STATE OF FLORIQA STATE OF COUNTY FLORIDA
COUNTY OF I�f a7d —
The forg ing instrument was acknowledged before me The forgoing instrumeept was acknowledged before me
this ay of I�.K\K ZO !J by this _day of ----`/) r St (�/ ,. 20 (��by
� � �7oVrcCiti b4111d' A"l ( J
(Name of person acknowledging') (Name ofperacknowledging )
(Signature o otary ublic- ate of Florida )`����\\SEROp �����i�� (—Signature Notary Public- ate of Flo`i, 1,"SEROO�
i
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Personally Known OR Produced] personally -Known- OR Producejiaae�+ p albp
Type of Identification Produced' o •. Jrpe of Identification Produced
d � 0eo
Qmmission No. /6AY 3% a1}E88371(,Commission Nor�.EE883717 A::
Revised 07/15/2014
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