HomeMy WebLinkAboutBUILDING PERMIT APPLICATION818812 100805QP,"4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: SCANNED Permit Number:
By RECEIVED
St. Lucie Countv
Building Permit Application FEB 11 iota
Planningand Development Permitting Department
P St. Lucie County
Building and code Regulation Division
2300 Virginia Avenue, Fort Plerce'FL34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:'8701 ORANGE AV
Legal Description: 11 ` 1 _tJyJ 111 OF SW 11� -WITH W ANT,> 1JI2 PSVYff OV IZ
E 20 "FT of 'F,w 1 /y UP SV\ t /y - l +� ot2aNGE AV A. c
Property Tax lb #: 2311 320-0000=0004 Lot No.
Site Plan Name: Block No.
.Project Name: .
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
upgrade AT&T equipment at exsiting telecom site
-- v�-..-•=..�I �...�;?r5':�� i s,� :�vv-�� ;---,—ter ..
CONSTRUCTION INFORMATION:
-Aclaitional worx tome peorme unclert is permit — cneCK all that apply:
_ HVAC _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric —Plumbing- _ Sprinklers _ Generator _ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floors
Cost of Construction: $ 19000 Utilities: —Sewer Septic Building. Height:
OWNER/LESSEE:
CONTRACTOR:
Name AT&T / Crown Castle - -
Name: Stanley Maclin
Address:6420 Congress Ave, Suite 2000, Beea4lak a;€L_aaaaz
company:. Master Network Solutions -- -
City: ZOM eoc�uI State: EL
Zip Code: 33HR, Fax:
Phone No. 561..544.4975
Address: 6100 Broken Sound Pkwy, Ste 6
City: ?)CccA &Ck aD Stater,
Zip Code: _? alb II Fax: .. "
Phone No. 561-962-9838
E-mail; SFLPermits@crowncastle.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: SFLPermits@crowncastle.Com
State or County License: CGC1515769
ltvalue of construction is $2500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain 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 intend to obtain financing, consult with lender or an attorney before
commencingwork or record' our Notice of Commencement.
Rev.B/2/17
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
-
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable.
Name: Florida Gas Transmission Co
BONDING COMPANY:
Name:
_Not Applicable
Address: % K E Andrews & Co 1900 Dalrock Rd Rowlett TX 75088
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ Lessee/Co ractor as Agent for Owner
Signat r Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDq /�
COUNTY OF
COUNTYOF I trYl L'� �O+C
The forgoing instrument was acknowledw�a�Jj��
The oing instr ent was acknowled a before me
this �1day orrf �gNVVGI���i�pmyM.thdayof'�Qnuar�/
.zo�' by
Name of persoq makir%sAat6ment�� S-
Name of pers making statement
Personally Known ✓ OR$odpced Identification
Personally Known OR-ProducedIdentification _
Type of Identification — Z '? �Q �• S C
*�
Type of Identification
Produced;d„ a
Produced
- y t .end Cd'a ��\:hPo�\
TATE OF �0 �—
Q��ti%LpJ2e.O.C.
/�S
(Signature of Notary Public- State of Florid 'Illll
(Signature of No -
h Notary Public Smote of FloridaMy
Commission No. (Seal)
�.rK
Commission No. Theresa