HomeMy WebLinkAboutBUILDING PERMIT APPLICATION851971-A21`0322 TMO-700
ALL APPLICABLE
/9INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / r�
Date: % • 7' ��D SCANNED Permit Number: 1 to02- (3 / y� CD.'1
T�—
BY
St. Lucie County RECEIVED
Building Permit Application FEB 0 3 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address. OTfO-S. OCEAN DR.
Legal Description:
Property Tax ID #: 4511-514-0000-000f=9 Lot No.
Site Plan Name:
Project Name: 851971 TMO-700
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
UPGRADING EQUIPMENT ON EXISTING TELECOMMUNICATIONS TOWER
Block No.
CONSTRUCTION INFORMATION: III
11U1J11CU UIIUCJ L111� NC1111IL-Ul
i
Gas Tank E]GasPiping
El Plumbing ❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 12,000
❑ Shutters ❑ Windows/Doors
❑ Generator ❑ Roof
S Ft. of First Floor:
Utilities:Sewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameT-MOBILE
Name: a4lzel , e, - 7,a,,6 Al
Address:1300 CONCORD TERRACE
Company:
City: SUNRISE State: FL
Code: 33023 Fax:
Phone No.561-922-1230
Address: 3060 dr6=4,we —Zip
City: J41-5 State: L
Zip Code: Fax: I-.?3G
Phone No. - 77 - S
E-Mail: adam.ehrlich@crowncastle.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: na a %� id o�i WAVN� �dCniy s . LOB
State or County License: g /rl
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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: hutchinson Island Club Condominium Inc
BONDING COMPANY: _Not Applicable
Name:
Address: 10410 s ocean D,
Address:
City: Jensen Beach FL 34957
City:
Zip:34957 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 approvedplans, 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
_ Signature 5f Owner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA /�
COUNTY OF A 11� fz3 p vv� COUNTY OF (` k i"
The fo going instrument was acknowledge efore me
this day of F—" 20/�by
lP?r_sonally Knownn\ OR Produced Identification
Commission No.
Revised 07/15/2014
ADAM EHRLICH
l6fa,)Public - State of Flory
Commission i FF 915138
The forgoing instrument was acknowledged before me
this�dayof ()C4- ,20�y
Assn
-e
Notary Pubifc- State of Florida )
OR Produced Identification
ADAM EHRUCH
No. = : Notajyd.2t#Ic - State of Hoiida
• ° Commission I FF 915136
=:a. x My Comm. Eaolres Soo 1. 2019
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