HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: :1 N4 SCANNED Permit Number: d d51 �—
y r BY RECEIVED
St. Lucie County
• i . �,�, JAN 2 3 2,j9i3
Building Permit Applicatio
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial TO-1C0110-IDn Residential N/A
PERMIT APPLICATION FOR: Other
;FROPCfSEDtHJIPRO�VEtytENm, 10N'
Addre�:-�7EBi}Okeechobee Road, Fort Pierce, Florida 34945-5010
Legal Description: 11 36 37 ALL LYG N OF SR 70-LESS ADDN RD RNV AS IN OR 1833-1194 (29.22 AC) (OR 213-492)
Property Tax ID #: 3111-122-0015-000-3 Lot No. N/A
Site Plan Name: ATC'2723 - Sprint M133XCO29-RimDitch-StLucieCo Block No. N/A
Project Name: ATC 2723 - Sprint MI33XCO29-RimDitch-StLucieCo
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
Telecommunications Tower Collocation -of -Electronic Equipment -.-Replacement, of existing transmission
panels on the cell t wer and electronicqu ep ent on ��
,und_level: _
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GOI�tS?RLIGTIOtSIrrll�t (tillltATtON _c r. .__ " . . ` • .. A#_ .: , .,i z X < ,
tiona wor tO e erformea unclerinispermit-c ec aii apply:
❑HVAC Gas Tank ❑Gas Piping I Shutters Q Windows/Doors
❑ Electric 0 Plumbing []Sprinklersi i Sprinklers , Generator ❑ Roof NSA Roof pitch
Toial Sq. FL Of Construction: 0 S-' Ft. of First Floor: N/A i
Cost of Construction: $ 20,000 Utilities: iSewer ❑Septic Building Height: N/A II
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Name 4S D C
Name: Benjamin Ekey
Address: is 54 0 S fir; A9
Company: ATS
city: dJe r l4rdt f k u)o r State: j?,-
-Zip Code41-,-5 ! Fax:- -- - - - --
Phone No.
Address: 450 S Ronald Reagan Blvd
City: -Longwood- _ State: FL _
Zip Code: 32750 Fax:
Phone No. 407-423-9071
E-Mail:
_
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Permitting@accessats.com
State or County License: SCC131150970
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCT10NjLIEN
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name: Benjamin ekey
Not Applicable
Add reSS: 270000keechobee Road, Fort Pierce, Florida34945.5010
Address:
City: State: FL
Zip: 32708 PhoneChrislopherJ.Wanen:813727-2484
City: Longwood
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name: Adams Ranch Inc
BONDING COMPANY:
Name:
_Not Applicable
Add reSS: 450 S Ronald Reagan Blvd
Address:
City: PO Box 12909. Fort Pierce, FL 34979
City:
Zip: 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.
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 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 in end to obtain financing, consult with lender or an attorney before
commencing work or recordi our Notice of Commencement.
Signature wner/ Lessee ontractor as Agent for Owner
Signatur�ontractor/LenseHolder
STATFft9R
ST E
COUNTYOF orange,
COUNTY OF0-ega
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
th{in�s_2 day of QE('.PLi')}Jt 2C,r .20� by
this 21 day of �-mber .20f� by
1 1\ A' IQ m I n l iIL 7 /v
Benjamin Ekey
— at 11— m�erso making statement
Name of person making statement
Personally Known X OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produc
(SigrrafurkrofNotarEfi atNalil6l@oetle$tataotFwrim
(S' n r o ota I I
Jerrica N Ruiz
�.Vd Notary Public Slate of Florida
My Commtpp}ig�IIGGG 15847a
Commission No. rplros 10/30)Z071
Janice N Rp'7����z
Commission No. y COrtlm1ae 798a 15847E
pia M1a�' Expires 10/30/2021
REVIEWS—
FRONT
ZONING
-SUPERVISOR
PLANS ---VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVI W
REVIEW
REVIEW
REVIEW
REVIEW
DATE
'11'1
RECEIVED
ks
DATE
G
COMPLETED
Rev.8/2/17