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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED %/ f�
Date: 13 / l / SCANNED Permit Number:
BY
St. Lucie Countv
Building Permit Application JAN 3 i 2017
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: Renovation
I PROPOSED IMPROVEMENT LOCATION: III
Address: 5690 Environment Dr, Fort Pierce
Legal Description: MODEL LAND CO'S S/D OF 6-36-40 S1/2 OF LOT 8 (4.637 AC) (OR 3263-1187)
Property Tax ID #: Parcel ID: 3406-501-0040.000-5
Site Plan Name:
Project Name: Sprint# M113XCO52
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: III
Modify Sprint Equipment; Add 3 antennas and 3 RRU (Remote Radio Units) to existing cell tower
I CONSTRUCTION INFORMATION: III
L IHVAC L I Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction: NIA
Cost of Construction: $ 15,000
Piping ❑_Shutters ❑Windows/Doors
nklers ❑ Generator E]Roof Roof pitch
_ S Ft. of First Floor: NIA
Utilities:Sewer❑Septic Building Height: NIA
OWNER/LESSEE:
CONTRACTOR:
Name Sprint
Name: ATS - Benjamin R Ekey
Address:6100 Sprint Parkway Overland Park, KS 66251
Company: ATS
City: Overland Park State: KS
Zip Code: Fax:
Phone No. 407-280-0958
Address: 2544 E Landstreet Rd Suite 600
City: Orlando FL State: FL
Zip Code: 32824 Fax:
Phone No. 321-418-0162
E-Mail:-dfowler@bluestreampro.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: cjanose@accessats.com
State or County License: SCC131150970
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:3414
DESIGNER/ENGINEER: X Not Applicable
Name: RoburtJ.1-araAR92624
MORTGAGE COMPANY:
Name:
X Not Applicable
Address: Two south tlnivesiy orive suite gas
Address:
City: Plantation FL 33324 State:
Zip: Phone: 954-577-4655
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name: FCCEnvironmentalLLC
BONDING COMPANY:
Name:
X Not Applicable
Address: 2175 Point Blvd Ste 375
Address:
City: Elgin. IL
City:
Zip: 60123 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
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Oc Q An6_ COUNTYOFCICZ6�_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1'S day of January 20 17by this day of January 20 1 7 by
of Notary Public -State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No.
Revised
A
EXPIRES June 04. 2019
EK
(Name of pers6n acknowledging)
(Signature of N9 ry c- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Public
10102=0
034963
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