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ALL APPLICABLE INFO MUST BE COMPLci r'D FOR APPLICATION TO BE ACCEPTED
Date: 12/17/15 Permit Number: V51 a—O3 �t
RECEIVED DEC 18 2015
Building Permit Application SCANNED
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: Alteration - c\h-ke v.."5 III
PROPOSED IMPROVEMENT LOCATION:. III
Address: 5690 Enviroment Drive.
Legal Description: Book 1727/Page 2952 Section/Township/Range:06/36S/40E
Property Tax I D #: 3406-501-0040-000-5
Site Plan Name: Verizon Wireless site 62005
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove and Replace 6 antennas and associated coaxial cable,
All work is on an existing communication tower.
Lot No.
Block No.
CONSTRUCTION INFORMATION:
❑Gas Piping apply:
❑Windows/DoorsAacitiona wor to e e orme under t s permit—c ec
❑HVAC EiGas Tank Shutters
❑Electric El Plumbing []Sprinklers _Generator ❑ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ O"
S Ft. of First Floor: _
Utilities:ll Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Verizon Wireless
Name: Michael Poirier
Address:777 Yamato Rd.
Company: J.Crompton Electric, Inc.
City: Boca Raton State: _
Zip Code: 33461 Fax:
Phone No.
Address: 1290 Old Congress Ave.
City: West Palm Beach State: FL
Zip Code: 33409 Fax: 561-585-9088
Phone No. 561-588-6559
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
E-Mail: DylanW@JCromptonelectric.com
State or County License: CGC62911
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Maria Martin /KlmleyHom
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 1920 Wekiva Way
Address:
City: West Palm Beach State: FL
Zip: 33411 Phone: 813-514-9880
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 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 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 Commencements ,
/4AL
—Signature of OwrZ ess Age
STATE OF FLORIDA
COUNTY OF Palm Beam
The forgoing ms ment w s acknowledged before me
this Y day of, 20LSby
Mark Morris VZWI Manager
(Name of person acknowledging )
State of
Personally Known -x OR Produced identification
Type of IdentificalliI Ila Pgodlgy�dnvl r.nl n mracula
z a
Commission # FF 123287
Commission No. ?;•>•i�- Expires May(g12W
'„p���,.` cl Tlwhayfmnlmwenre9ro33-]o19
Revised 07/15/2014
re
STATE OF FLORIDA
COUNTY OF Palm Beam
The forgoing instrument was acknowledged before me
this 15 day of December 20 _by
Michael Poirier
(Name of person acknowledging)
Public- State of Florida )
Personally Known X I
Type of Identification Pr,,Yliytgd
Commission # FF 123287
Commission No. >;•` Expires May ftymp
TTry Tmy Fm In: mncel;D 3 7019
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