HomeMy WebLinkAboutBUILDING PERMIT APPLICATION800642 Sp:, Do Macro U�grade;,MI72XCO13
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1�
Date: %6I A I 1 1 Permit Number: \1 1 d '61 1 O
,- .:'I— _. RECEI%,'-D OCT 092017 SCANNED
• .�, BYBuildin Permit Application St. Lucie County
Planning and Development 5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Cgmmercial Residential
PERMIT APPLICATION
Address: 16800 OKEECHOBEE RD
Legal Description: 136 38 THAT PART OF W 1/2 OF SEC LYG NLY OF SR 70-LESS CANAL RS/W AND
136 38 THAT PART OF W 1/2 OF SEC LYG NLY OF SR 76-LESS CANAL RS/W AND LESS OKEE RD...
Property Tax ID #: 3201-244-0039-000-8 Lot No.
Site Plan Name: Block No.
Project Name: 800642 Sprint DO Macro Upgrade
Setbacks Front Back: Right Side: Left Side:
Upgrade of equipment at existing cell tower.
Hacn onai work co oe erlanneU unuer uirs penna—arecn du I dppry:
ElGas Tank Gas Piping _ Shutters ❑ Windows/Doors
11 Electric Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 20,000 Utilities:qnSewer 0 Septic Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name Sprint/Crown Castle
Name: Richard Lee Cullum
Address: 6420 Congress Ave, Suite 2000
Company: Crown Castle USA, Inc.
City: Roca Raton State: FL
Zip Code: 33487 —Fax: 724.416.6553
Phone No. 561.922.1230
Address: 1142 Celebration Blvd.
City: Celebration State: FL
Zip Code: 34747 Fax:
Phone No. 724.416.2971
E-Mail:adam.ehrlich@crowncastle.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E;Mail: richard.cullum@crowncastle.com
State or County License: CGC062125
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. t a I i
1
'SUPPLEMENTAL CONS_TRUCTIONTIEN,LAW 9NFORMATION;
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:,
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name: Evans Properties Inc
BONDING COMPANY: _Not Applicable
Name:
Address: 660 Beachland Blvd Ste 301
Address:
City: Vero Beach, FL
City:
Zip: 32963 Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
no
ize the permit holder to build the subject structure
s or and covenants that may restrict or prohibit such
r 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 recos&g your Notice of Commencement.
j Z4tu La. —
Signature of Own r/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIr
COUNTY OF Palm Beach
COUNTY OF a
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledgedltefore me
C-1— �7_
this To day of 0 C-{— 20 1-7bythis
day of D 20 by
CvI (()11-
Elvis Anico
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Name of person making statement
Name of person making statement
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signat otary Public- State o on
^1'-,
r otary Pub
uu„' ADAM EHRLICH
Commission No. S �` �""'ba��( �ify Public -State of FIo
Ina
P,B, ADAM EHRLICH
mission No.FF / e°, .�: Na(8eN*Iic - Stale of Florid
Commission N FF 91513Commission
S FF 916138
My Comm. ExpiresSep 1, 20f
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DATE
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Rev.8/2/17 1 v/