Ttower & Co-Location Antennas Application Form
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2TOWER & CO-LOCATION ANTENNAS APPLICATION
Effective FBC 5th Edition 2014
EFFECTIVE CODE IS 2010 FBC
NON-REFUNDABLE APPLICATION FEES DUE AT TIME OF SUBMITTAL / APPLICATIONS IN PENCIL WILL NOT BE ACCEPTED
ROW ID#________________________________
PMT# _______________________________________________
TAX PARCEL NUMBER:
______________________________________________
Short_____________-__________-__________-_____________ / Long
Property Owner: Name_______________________________________________________________________
Address_________________________________________________________________________________________________________________
Phone # :_________________________________ E-Mail:________________________________________________________________________
Tower Owner: Name__________________________________________________________________________
Address_________________________________________________________________________________________________________________
Phone # :_________________________________ E-Mail:________________________________________________________________________
Antenna Owner: Name_________________________________________________________________________
Address_________________________________________________________________________________________________________________
Phone # :_________________________________ E-Mail:________________________________________________________________________
COMPLETE PROPERTY ADDRESS:
Number
Street Name
Between Streets:
___________________________________________
City
Suite/Lot
_______________________________________
And
County
Zip
WORK PROPOSED:
Scope of Work:______________________________________________
Current Use_________________________________________________
__________________________________________________________
Total Number of Antennas: __________________________
__________________________________________________________
Tower Type:________________________
__________________________________________________________
Height of Tower:_______________________
__________________________________________________________
Equipment Building? _____Yes
_____No
DECLARED PROJECT COST: (Include labor & materials) $
.00
ELECTRICAL INFORMATION: Yes
No
New Service?
Existing Service?
Upgrade Service? Number New/Altered Circuits
___________________
________
Power Company
:
Service Size: NEW Amps
Volts
Phase 1PH
3PH
OLD Amps
Volts
Phase 1PH
3PH
__________
___________
_________
__________
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a
permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I agree to allow County Personnel to enter upon this
property to inspect development permitted by this application. OWNER’S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done
in compliance with all applicable laws regulating construction and zoning. 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 job site before the first inspection.
If you intend to obtain financing, consult with your lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Applicant__________________________________________________________________ Date_________________________
Check one: ______ Owner/Builder
Contractor or Authorized Agent
(Must personally appear in office & sign)
_______
(Agent must submit power of attorney)
STATE OF FLORIDA
COUNTY OF_
_________________________________
Affirmed and subscribed before me this _________ day of ___________ 20_____ by_________________________________________________________
Personally known______ or Produced Identification_______
Type of Identification Produced
______________________________
______________________________________________________________
Signature of Notary Public State of Florida
Seal:
______________________________________________________________
Print, Type or Stamp Name of Notary
**Information on back must be filled out completely**
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