HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3Tl I 1 Permit Number: VI
R E C E P117 D 'I11R 02 2017 SCANNED
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: Alteration
PROPOSED IMPROVEMENT LOCATION:
Address: 1480 Dyer.Road, Port St. Lucie 34952
Legal Description: Book 1115 / Page 1983 Map ID#: 34/23S
PropertyTax ID #: 3414-501-0716-000-0 Lot No.
Site Plan Name: Block No.
Project Name: Verizon Wireless Site# 62707 ST. LUCIE RELAY
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: III
At existing communication tower, modification of 6 existing antennas. Also install 6 diplexers, 6
triplexers and 3 BIAS-T units at antennas. Also install 6 diplexers, and 6 triplexers at grade.
CONSTRUCTION INFORMATION:
Additional work to e ertormed under
tispermit—check
all apply:
0HVAC GasTank
E]GasPiping
_Shutters
Windows/Doors
Electric 0 Plumbing
[]Sprinklers
Generator
Roof
Total Sq. Ft of Construction:
S. Ft. of First Floor:
Cost of Construction: $ 21,000
Utilities:t Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
_ . _.
Name Verizon Wireless
Name: Anthony Ankersmit
Ld05')
Address:7701 Telecom Parkway
Company: UCI Construction Services, LLC
City: Tampa State: FL
Zip Code: 33637 Fax:.
Phone No.
Address: 7103 East 6th Avenue
City: Tampa. State: FL
Zip Code: 33619 Fax: 813-386-6204
Phone No. 813-386-6202
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ddrury@ucics.net
State or County License: CGC1517870
If value of construction is $2500 or more, a RECORDED Notice of Commencement is_ required. 3d &JI
N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name: Hugh Reilly/ CBVR Telecom Design Name: N/A
Address: 5113 MemoHalHighway Address:
City: Tampa-- State: FL_ City:
Zip: 33517 . Phone: Zip: Phone:
Not Applicable
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: American Tower Systems, Inc. Name: N/A
Address: P.o.B-723597 Address:
City: Atlanta, GA City:. _
Zip: 31139 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 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 recordine vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
,U . s
Signature ofContractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF HIusBORoucH COUNTY OF HILL590R000H
The forgoing instrument was acknowledged before me
this 27th day of FEBRUARY 20 17 by
The forgoing instrument was acknowledged before me
this 27 day of FEBRUARY 20 _by
ANTHONY ANKeksmiT Anthony Ankemmit
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public -State of Florida (Signature of Notary Public -State of Florida )
Known x OR Produced Identification
Type of
Commission No.
Revised 07/1.
�?( � R.ONUBY
NoterA011E - State of Florida
Commission a.EF 973213
Personally Known x OR Produced Identification
Type of Identification Produced,,_ _ _ _
Commission No.
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