PERMIT DOCUMENTS
CITY OF BOYNTON BEACH
DEVELOPMENT DEPARTMENT | BUILDING DIVISION
100 East Boynton Beach Boulevard • Boynton Beach, FL 33435 • (561) 742-6350 • Fax 742-6357
APPLICATIONFOR:EXTENSIONREINSTATEMENT
SELECT ONE: x Permit Permit Application (max of (3) three extensions)
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Project Name
: ____________________________________
Permit #Job Address:
Unit #
74:!Tovh!Ibscps!Es!
31.1:88
Contractor of Record:
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Phone:
Email:
865.428.9793cqthjodAhnbjm/dpn
Mailing Address:
22147!Tvotfu!Sjehf!Djsdmf
CityState:Zip Code:
Gmpsjeb
44584
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Detailed reason for the extension:
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Uif!tqpvtf!sfuvsofe!sfdfoumz!boe!xf!xbou!up!dmptf!pvu!uif!kpc/
I, the undersigned, am requesting an extension/reinstatement for the item indicated above. I understand that
submittal of this form does not constitute in itself approval of the extension/reinstatement.
5.:.3132
Qualifier:
Signature Date
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Printed Name
FOROFFICIALUSEONLY
DateofExpiration:ProcessingTechnicianInitials:________
stndrd
ApplicationExtension(maxof(3)threeextensions):1$50.002$75.003$100.00
stndrd
PermitExtension:1$50.002$75.003$100.00Extensionbeyond90days$250.00(Requires
BuildingBoardofAdjustment&AppealsApproval)
PermitReinstatementFee:
TotalPermitValue:______________________
Times2.3%
Under180daysofinactivestatus
PermitFee:______________________
Over180daysofinactivestatusor
Times30%
Over180daysofinactivestatus
ReinstatementFee:______________________
(Whicheverisgreater)
Approved,extendedfor_________daysDenied**AdditionalImpactFeesmayapply
5.:.3132
________________
ReviewedbyBuildingOfficialDate
S:\\Development\\BUILDING\\FormsTemplatesSigns\\ApplicationforExtensionorReinstatement.docx