HomeMy WebLinkAboutBUILDING PERMIT APPLICATION`;%642
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f' �' �' Permit Num
Building Permit Applicatio
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR:
__ 1V V. 0l7 V.
0 EN
OCT 08 P018
Permitting Department
St. Lucie County, FL
PROPOSED IMPROVEMENT LOCATION: III
Address: _16800 Okeechobee Road
Legal Description:
Property Tax 1D #t: 32-01-244-0039-0008 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
upgrade tele om equi ment at existing cell site - Eligible Facilities Request under Sec 6409
t1�r,dts""'"^�'�5RUsj.l She �uppasbor SCANNED
BY
St. Lucie Counf /
CONSTRUCTION INFORMATION: III
�HVAC
v Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ M00
—Gas Piping
_Sprinklers
—Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Roof pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam(AT&TL'Crown Castle
Name: Stan Machn
Company: tylastec Network Solutions
Address: 4511 N. Himes Ave Suite 210
City: Tampa State: FL
Address: 6100 Broken Sound Pkwy, Ste 6 _
Zip Code; 33614 Fax:
City: Boca Raton State: FL
Phone No. - -
Zip Code: 33487 Fax:
E-Mail: donna.carroll n�icrD.Wci;dstle:com
Phone No. (813) 342-3852
Fill in fee simple Title Holder on next page (if different
E-Mail: donna.carroll@crowncastle.com
State or County License: CGC1515769
from the Owner listed above)
IT vaiue or construction is ,S251J0 or more, a RECORDED Notice of Commencement Is required.
•*r
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: EVANS PROPERTIES, INC.
Address: 660 Beachland Blvd, Ste 301 Vero Beach FL 32963
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
Zip:
_Not Applicable
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 Assoclation 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.
Inconsideration 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 recordine vour Notice of Commencement.
Signature of Ownail Lessee/Contractor as Agent for Owner
Slgnatur tractor/Ucense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF i�Ft 4 tN,6Cdt✓
COUNTY OF �Ov_Warrl CO,;,4y
The forming instru ent was acknowledged before me
The forgoing instrument was acknowledged before me
this Oday of CV '( 6X. 20JE by
this 'a day of (9^lr)b/T V 20 IF by
�i�ZY �n'.c.� t111111111
L.taG F. )
Name of s
*
Name of person making
Personally Knownper�making OR P ucelil, ' t V/
Personally Known Produced Identification ✓
Type of Identification SPC{e'•��/�—
Produced �' ,� $
Type of Ida tification
Producedyrux 6LG,Vksu
S
(Signature of otary Public- Stagg TtJi'Uoder�,�
(Si nature of Notary Public
d.•A;p • ; or UNIQUE-NICOLI NOBLE
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Commission No.
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Commission No, t?/'f%
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":gFf„9•' Bonded Thn, Notary Public Undaniall
Apam—
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
If
tt�l
DATE
COMPLETED
Rev.8/2/17