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ALL APPLICABLE INFO MUST'BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' �/' 17. Permit Number: 1-71 1.
5 V
ED
_ NOV 2 l 2017
Building Permit Application
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 Resident Iial X
PERMIT APPLICATION FOR: Other
PROPOSED-IMPkOVEMErNT1OCATION:
Address: 5903 Yucca Dr Fort Pierce, FL 34982
Legal Description: INDIAN RIVER ESTATES-UNIT 09-BILK 79 LOT 26 (MAP 34/12S) (OR 2175 I1240)
Property Tax ID#: 3402-610-0291-000-2 Lot No.26
Site Plan Name: INDIAN RIVER ESTATES-UNIT 09 Block No. 79
Project Name: M SUSAN JACKSON SOLAR PHOTOVOLTAIC
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ''
I�
INSTALLATION OF A ROOFTOP SOLAR PHOTOVOLTAIC (ELECTRIC) GENERATOR. GRID
TIED ONLY, NO BATTERY BACKUP
CONSTRUCTION]N FORMATION �
Additional work to eperformedd under this permit-check a apply:
EIHVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers 1:1Generator El R lof
Total Sq. Ft of Construction: S Ft.of First Floor:,
Cost of Construction:$ 33,000.00 Utilities:n Sewer F]Septic Building Height:
,'OWN.ER/LESSEE CONTRACTOR.
Name M Susan Jackson Name: JUSTIN HOYSRADT
Address:5903 Yucca,Dr Company:-VINYA$UN CORPOF2ATION
City:: FORT PIERCE', State:FL Address: 31aDATURA STREETIISUITE 101
Zip Code:.34982 Fax: City: WEST PALM BEACH State:FL
(401)374- 44 ; Code::33401Phone No. p Fax:
E-Mail:suejaxx@gmail.com Phone No. 561-44d=9516
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITTING@VINYASUN.COM
from the Owner listed above) State or County License: CVC 56967
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLE MENTAL CON STRUCTION'LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: -_-SusTun AAo!As(dtd*, MC, 10"3.`L2 Name:
Address: 3 c-,1wo, S-r 10% Address:
city: 't kLum examn State: City: State:
Zip: 33;401 Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
commencing work or recording our Notice of Commencement.
s
_Signature o wner/Lessee =LO
ontracto L e H Ider
STATE OF FLORID RI ,J
COUNTY OF �G¢ n , COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrunlent was acknowledged before me
this day of &PJ��j -2 0 J2by this�day of Mll"be$4,20 a by
(Name of owI dging) (Name of person acknowledging
(Signat r o Notary Public-S of Florida) (Signature of Notary Public- of Florida)
Personally Known_��OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Gp: .•'S' Commission No. 9 SCHF���,�,�
a a oV F�
4 OP .....087893
,9/ �.
Revised 07/15/2014 ,p
REVIEWS FRONT Z�j }� ho0 4PERVISOR PLANS VEGETATION SEA�+y�r "� + 67�/E
l '7'.rc� EL6Gs U7r.
COUNTER REVIEW REVIEW REVIEW REVIEW REVf (/ ' {AWE"
DATE Will
COMPLETE
INITIALS