HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE I FO MUIT BE COMPLETED FOR APPLICATION TO BE ACCEPTED f Date: 171 Permit Number:
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Building Permit Application BY
Planning and Development Services 5t. 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: 21715 Orange Avenue, Fort Pierce 34945 (Verizon Wireless Site#
Legal Description: Book 3416 / Page: 2378
Property Tax I D #: 2208-311-0001-000-6 Lot No.
Site Plan Name:
Project Name: Verizon Wireless Site# 68837 ADAMS RANCH
Setbacks Front Back: Right Side: Left Side:
Block No.
DLTAILEDbESCRIPTION OF WORK: s:
MODIFICATION OF CELL TOWER TO IMPROVE THE STRENGTH AND INTEGRITY OF
EXISTING GUYED TOWER TO ACCOMMODATE THE PURPOSED ANTENNA UPGRADE
uauiondi worn co oe
❑HVAC
❑Electric
TJerrorrneu
unuer finis perms—aiecn du
Gas Tank ❑Gas Piping n
Plumbing ❑Sprinklers ❑
dppry:
Shutters ❑ Windows/Doors
Generator ❑ Roof
❑
Total Sq. Ft of Construction:
Cost of Construction: $ Q�00 }
S Ft. of First Floor: _
Uti I ities:n Sewer ❑ Septic
Building Height:
OWNER%LESSEES
4-
CONTRACTOR
Name Verizon Wireless
Name: Alan Zirkelbach
Address:7701 Telecom Parkway
Company: Ascend Wireless Networks, Inc.
City: Tampa State: FIL
Zip Code: 33637 Fax: / I
Phone No.- el_ ?? i
Address: 756 Business Park Blvd. STE 103
City: Winter Garden State: FL
Zip Code: 34787 Fax: 407-386-6961
Phone No. 407-451-0474
E-Mail:V ap m. Ga.T aSee
r`� rr-dt'eu
in fee simple Title Holder on next page (i�pdi ferent
from the Owner listed above) cd
Veronica.carmean@ascendwirelessnetworks.com
ascendwirelessnetworks.com E-Mail: ca
State or County License: CGC1521965
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN, LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY:
x Not Applicable
Nance: Maria Martin /Kimley-Horn&Assoc., Inc.
Name:
Add resS: 1920 Wekiva way
Address:
City: west Palm Beach State: FL
City:
State:
Zip: 33411 Phone: ee1-845-06e5
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
x Not Applicable
_
Name: 4H Ranch, Inc.
Name:
Address: P.o.Boxt4920
Address:
City: Ft. Pierce, FL
City:
Zip:34979 Phone:
Zip:' Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count yy 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
commencine work or recordin¢ vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
1
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF MatlCi, e
The forgoing instrument was acknowledged before me
this I o day of T/ti � . 20 ] Z by
a,0 Zi-r, b .
(Name of rson acknowl dging )
na ure of d6tary Public - State of Florida )
Personally K dgfNdiS[S
Type of Identl ic4io,groq[sxoPublicState of Florida
Lacey N Stovall
Commission �' o� My Commission FF 10.8�d1)
o.n neaota 1�
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