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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION5800427 Verizon PCS ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: -SN sl 11 Permit Number. `�j d3�d(•o9 ro RECER".El MAR 312017 • b(. ED Building Permit Application gy Planning and Development Services St. Lucie County Building and Code Regulation Division 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 13 PROP..OSED'I MP,ROVEM ENTi'LOCATIQN; Address: 6425 RUSSAKIS RD Legal Description: Property Tax ID #: 1303-243-0001-000-7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: .,DETAILEDFDESGRIP,TI©NIOF WORK:: upgrade equipment at existing cell site ;C-ONSTRIJCTIONIINFORMATION: AdchtlonalworKtolifenerTormecl uncierthisperms -check all appy: LHVAC GasTank []Gas Piping Shutters ❑ Windows/Doors . jj��_II Electric El Plumbing Sprinklers L� Generator Roof Roof pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: 14,000 Cost of Construction: $ Utilities: Sewer Septic Building Height: 011NNER%LESSEE: ICON!,IRACTOR. Name Verizon I Crown Castle Name: Alan P Zirkelbach Ad dress: 6420 Congress Ave., #2000 Company: Ascend Wireless Networks, Inc. City: Boca Raton State: FL Address: 756 Business Park Blvd Ste 103 City: 'linter Garden State: FL Zip Code: 33487 Fax: Phone No. Zip Code: 34787 - Fax: E-Mail: Phone No. Fill in fee simple Title Holder on next page ( if different E-Mail: State or County License: CGC1521965 from the Owner listed above) If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required, SUPPLEMENTALCONSTRUCTION LIEN.LAW.INFORMATION: DESIGNER ENGINEER: Name: Address: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: City: Zip: Phone: State: City; Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: Russakls Investments LLC _ Not Applicable BONDING COMPANY: Name: _Not Applicable Address: 8801.inddo Rd Address: City: Fort Pierce, FL City: Zip:34951 Phone: Zip: Phone: I certify that no work or Installation has commenced prior to the issuance of a permit. :e the permit holder to build the subject structure or and covenants that may restrict or prohibit such 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 1_ s rector as Agent for Owner Signature of Contractor/License Holder STATE OFFLORI7t[ COUNTYOFORI, COUNTYOF h .. OF The forgoing instrument was acknowledged.pefore me The forgoing instrument was acknowledged before me this?1l day of ✓- � 4+ . 20 l ,by this??( dayof &62mAA4 2D 1_% by (Name of person acknowledging ) (Sigma i of Notary Public -State of Florida J Personally Know OR Produced Identification Type of Identification Produced Commission No. am•, (Seal) ADAM EHRLICH +. �: Notary Public - State of A0,1 7'� ie_.J_'00_CA - (Name of psryon acWowledging ) (Signature fo�Otar Public -State of Florida ) Personally Known t/ OR Produced Identification Type of Identification Produo "K, e Notary Public State of Florida dCo mission No. o Lpjglrr Stovall My Cortfmission FF 108131 € Expires 04/18/2018 My Comm. Expires Sep 1, 2019 Revised07/15/2014 80ndedfhmuohNatinnalNMarvAc,n REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS