HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I�'`L— S Permit Number: i`J 16 -6d3I
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Building Permit Application BY
Planning and Development Services St. Lucie Countv
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 6375 S U S 1 , PORT ST LUCIE, FL 34952
Legal Description: MODEL LAND CO'S S/D OF SEC 15 36 40 BILK 2 LOT 2-LESS RD RAN OF US 1-
AND LOTS 3 AND 6 AND LOT 8-LESS W 33 FT FOR RD AND CANAL R/W- IN NW 114 (MAP 34/15N) (39.00 AC)
Property Tax ID #: 341550100210004 Lot No.
Site Plan Name: MP,'I A-2 ROW;lGhA Block No.
Project Name: Metro A2P0305
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Tower Work- replace w (O neW
CL"i-2nn0Le- lylr'{aI 1 61) (:ovpf 63) LTS Q RU) (2)UHT5 P, aUf Jiplexer
bori12'i $C3)TMAs Fleck imi ►S►D-QQtZ
CONSTRUCTION INFORMATION:
Acloitional worK to be erformed under tispermit—check all apply:
1]HVAC Gas Tank ❑Gas Piping In _Shutters Q Windows/Doors
HElectric 0 Plumbing Sprinklers O Generator Roof
_Total Sq. Ft of Construction: S Ft. of First Floor:
=Cost. of Construction:-$ 1040001 Utilities: SewerSeptic Building,Height:
OWNER/LESSEE:
CONTRACTOR:- -- - - -- - -- - ---
Name T-Mobile/Metro PCS
Name: Daniel Ault
Address:1300 Concord Terrace
Company: Glotel
City: Sunrise State: FL
Address: 3060 Orange Grove Trail
City: Naples State: FL
Zip Code: 34986 Fax:
Phone No. 561-748-0302
Zip Code: 34120 Fax:
E-Mail: hvaidez@rgpartners.com
Phone No. 239-776-5884
Fill in fee simple Title Holder on next page ( if different
E-Mail: danault@olinwaynecompanies.com
State or County License: big I �l
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x
1PJ(igName: mmrtu: A
Not
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MORTGAG ECOMPANY: Not Applicable
Name:
Address: T,�o S,
i S
CIS
Address:
City: A[1 v
Zip: _Maq Phone: 'I.
State
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City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Name: -1 cla P ,o4.
Not Applicable
L'
BONDING COMPANY: Not Applicable
Name:
Address: b
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counter 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,
cessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
W NING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
imp ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor a first inspection. If you intend to obtain financing, consult with lender or an attorney before
comme R work or recordine vour Notice of Commencement_ / 1
—Signature of Owner/
STATE OF FLORIDA N STATE OF FLORIDA
COUNTY OF PC, iy,n &li COUNTY OF a166V'4761'_
The f r ing instrument vlas acknowled before me
thi=y of IIJ
1 2Q y
1 V®al
[Name of person acknowledging)
(Signature of Notary PublicXa(t'e of
The forgoing instrument was acknowledged before me
this / day of 3'4(y 20 /S by
An e l %aL(L T
(Name of person acknowledging)
(Signature
rcuuiwuy nuuwn - — - —uK YrouucealOentinCationonally=Known—Y--OR Prop
Type of Identification Produced Type of Identification Produced
—
Commission gkY P", HOLIyy DFZ 00 ?7—
Commission No. •. WCOMM15$��lFF005211 Commission No.
Revised 07/15/2014
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