HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO. MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 102A \1 Permit Number: 1l a3- OOS
RECEIV_D i.;AR 02 2017 SCANNED
Building Permit Application By
Planning and Development Services St. Lucie Counti,
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 III
PROPOSED IMPROVEMENT LOCATION:
Address: 01401 Swain Road, Fort Pierce 34947
Legal Description: Book 3535 / Page 697
Property Tax ID #: 2418-242-0001-000-0
Site Plan Name:
Project Name: Verizon Wireless Site# 62728 SBA St. Lucie Aero Communications
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
At existing communication site, modification of 9 existing antennas. Also to install 6 diplexers, 6
triplexers, and 6 BIAS-T units at antennas. Also install 6 triplexers at grade.
CONSTRUCTION INFORMATION:
Aaamonalworl(tobenertormed under tispermit—check all apply:
11HVAC Gas Tank Gas Piping _Shutters ❑ Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator 1:1 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ �(ODO
ScI�Ft.I of First Floor: _
Utilities:L)Sewer ElSeptic
Building Height:
OWNER/LESSEE: -
CONTRACTOR:
Name Verizon Wireless
Name: Anthony Ankersmit
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 52500 or more, a RECORDED Notice of Commencement is required. W��7
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Hugh Reilly/ Caltrop Telecom
MORTGAGE COMPANY: x Not Applicable
Name:
Address: 5113 Memorial Highway
Address:
City: Tampa State: FL
Zip: 33534 Phone: 770-853-1233
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: Juanand Carol Alas
BONDING COMPANY: _Not Applicable
Name:
Address: 258 SW Reynolds Ave.
Address:
City: Port St. Lucie, FL -
City:
Zip:34983 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 considerationof 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 vour Notice of Commencement.
S
_ Signature. of Owner/ Lessee/Agent Signature ofContractor/Lice se Holder
STATE OF FLORIDA STATE OF FLORIDA 9
COUNTY OF HIUSBOROUGH COUNTY OF HILSBORGUGH
The forgoingacknowledged
o N
Ins g
The forgoing instrument was acknowledged before me' trument was acknowled ed before me
this _ day of 20 _by this 27 day of FEBRUARY 20 _ by
Q U O
m � N
ANTHONY ANKE4SMIT ANTHONY ANKERSMIT 0 Q, E
(Name of person acknowledging) (Name of person acknowledging)
z
heb{n__ •.
(Signature of Notary Public- State of Flor' ) (Signature of Notary Public- State of Florida =�
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Prod a of Identification Produced
., •'pY °�e'% DEBRA M. DRURY - x•••r a.
Commission No. FF973213 r°. �1�': mission No. FF973213 ,�J�j ;,; Sep BRAM.ORUH.
. E MR Public - Stfte-ot-Floi � 9 ,A, Noiary �ubllc - State Florida
'a Commission B FF 91321 ' _ Commission alFF 1213
Revised 07/15/2014
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