PERMIT DOCUMENTS •
UNIVERSAL COUNTY-WIDE/MUNICIPAL FOR OFFICE USE ONLY
BUILDING PERMIT APPLICATION FORM FIX Version: Permit Type:
January 2020 Edition Accepted By: Application Date:
Approved for use throughout Palm Beach County and Munidpalkles Application it:
KIND of PERMIT(CHECK ONE): PROPERTY OWNER: Sti6Idd� /2frtee"
❑PRIMARY PERMIT TENANT: 1-c''t'-(i1T1t R'
121SUB-PERMIT-If Fee&Value of a Sub-Permit are ADDRESS: 31 0(0 6 COL Ati'IJ t. UNI
covered under a Primary Permit,complete boxes;,3,4.5.6.$L CITY: $0-\1 rJ �4i STATE: ( ZIP:93 1�'
8 only to apply.If not covered under a Primary Permit,
complete the entire application to apply. PHONE: FAX:
PRIVATE PROVIDER:❑PLAN REVIEW ['INSPECTIONS EMAIL:
3
TRADE (CHECK ONE): • PROJECT NAME: RATNER. SHELDON & BEVERLEY
❑STRUCTURAL ❑ROOFING ❑ELECTRICAL PCN: Q $-g I-A B_-11Q-a Q-Q Q Q-Q I Z Q
❑ MECHANICAL ❑PLUMBING ❑FIREjCAs
❑ OTHER: LEGAL DESCRIPTION:WINDSOR AT HUNTERS RUN CONDO UNIT 37
PRIMARY PERMIT#: to' 2913 PROJECT ADDRESS: 37 WINDSOR DRIVE
CITY: BOYNTON BEACH, FL 33436
S
FURTHER WORK DESCRIPTION:INSTALLATION OF 500 GAL TANK AND LINE TO SUPPLY GENERATOR,COST OF PERMIT IN ELECTRICAL PERMIT
Type of Work:Sew ❑Addition DAlteration ❑Repair ❑Demo ['Temporary ['Other
VALUE: `z bOaa. PERMIT FEE: NET S.F(for SFD's):
ISEE FEES&EWIEI pS APPIJE51 (AS APPUES)
6
❑ OWNER BUILDER PER FL.ST.489(AS NAMED ABOVE,FOR CONTACT INFORMATION SEE BOX 2)
® CONTRACTOR(CERT.HOLDER): RODNEY ROSADO License it: LG4347/6375
DBA(COMPANY NAME): ALLGAS SERVICE INC Contact Person: RODNEY ROSADO
ADDRESS: 5450 SE PINE AVENUE STE: CITY: STUART STATE: FL ZIP: 34997
PHONE: (954)325-7348 FAX: (7721288-2696 EMAIL: ALLGASSERVICEINC(rD_GMAIL.COM
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 understand that a separate permit must be secured for ELECTRICAL
WORK, PLUMBING,SIGNS,WELLS,POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.
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.
: e
Sser�
tore at owner or INteFntl@MA
ung 1 (9 of cona�al
Print Name: PO')mj-61 '�bad
7Print Name: RODNEY ROSADO
NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/ NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/
BUILDERS REGARDLESS OF$VALUE STATE OF FLORIDA BUILDERS REGARDLESS OF$VALUE STATE OF FLORIDA
COUNTY OF COUNTY OF A t(1
Sworn to(or affirmed)and subscribed before me this Sworn to r as rmed)and subscribed before me this J1
day of , 20 ,by day of IPIHCJ•( ,t)QT^ , 20 , (2 ,by
(Name of personmaking statement)
e 1 ` 1lJ c11/560(Na mPes�aW�n��m(�nawlkin1gvsn' 1
Lea
(signature of Notary Public-State of Florida) ( ture of Notary P Bic-State of Florida)
I.jf}n , USIA
(Print,Type,or Ste mmissloned Name of Noblic) (Print,Type,or Stanglo lssioned Name of N• . •ublic)
Physical Presence OR Online Notarization`f$[YIJIf is Physical Presence OR Online Notarization
Personally Known OR Produced Identification Personally nown _ OR Produced Identification J
Type of Identification Produced Type of Id.3 t (y.ProduceW 1, a• . L .�
``r" Notary Pj+Mir cone(n
Commission a GG 094114
` +'.•' My Comm.Expires Apr 13,7071 Page 1 oft
.' ..........' Bonded Ihmugh National Notary Assn.
ism,. _ - -
UNIVERSAL COUNTY-WIDE/MUNICIPAL FOR OFFICE USE ONLY
BUILDING PERMIT APPLICATION FORM FBC Version: Permit Type:
January 2020 Edition Accepted By: Application Date:
Approved for use throughout Palm Beach County and Municipalities Application tJ:
1 2
KIND of PERMIT(CHECK ONE): PROPERTY OWNER:
['PRIMARY PERMIT TENANT:
I SUB-PERMIT-If Fee&Value of a Sub-Permit are ADDRESS: UNIT:
covered under a Primary Permit,complete boxes 1 14.5.6 $ CITY: STATE ZIP:
8 only to apply.If not covered under a Primary Permit,
complete the entire application to apply. PHONE: FAX:
PRIVATE PROVIDER:❑PLAN REVIEW['INSPECTIONS EMAIL: •
.
TRADE (CHECK ONE): PROJECT NAME: RATNER. SHELDON &BEVERLEY
❑STRUCTURAL ❑ROOFING ELECTRICAL PCN: 11-A_ .1 A Q 1-2 1-_Q Q 1-1 I L Q
In MECHANICAL [(PLUMBING FIRE RGAS LEGAL DESCRIPTION:WINDSOR AT HUNTERS RUN CONDO UNIT 37
❑ OTHER: P�
PRIMARY PERMIT#: PROJECT ADDRESS: 37 WINDSOR DRIVE
CITY: BOYNTON BEACH FL 33436
I
FURTHER WORK DESCRIPTION:INSTALLATION OF 500 GAL TANK AND LINE TO SUPPLY GENERATOR,COST OF PERMIT IN ELECTRICAL PERMIT
Type of Work:Sew [(Addition [(Alteration El Repair [(Demo [(Temporary [(Other
VALUE: ''4 bO v PERMIT FEE: - NET S.F(for SFD's): •
(SEE FEE SCHEDULE( (AS APPO6) (AS APPU6)
❑ OWNER BUILDER PER FL.ST.489(AS NAMED ABOVE,FOR CONTACT INFORMATION SEE BOX 2)
® CONTRACTOR(CERT. HOLDER): RODNEY ROSADO License tt: LG4347/6375
DBA(COMPANY NAME): ALLGAS SERVICE INC Contact Person: RODNEY ROSADO
ADDRESS: 5450 SE PINE AVENUE STE: CITY: STUART STATE: FL ZIP: 34997
PHONE: (954)325-7348 FAX: (772)288-2696 EMAIL: ALLGASSERVICEINC@GMAIL.COM
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 understand that a separate permit must be secured for ELECTRICAL
WORK,PLUMBING,SIGNS,WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.
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.
I — g
14xnat wnerorAgen (Inducting co w Nola -of Contractor]
Print Name: w.r —" a°d Print Name: RODNEY ROSADO
NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/ NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/
BUILDERS REGARDLESS OF$VALUE STATE OF FLORIDA BUILDERS RE RDLE OF$VALUE STATE OF FLORIDA
COUNTY OF COUNTY OF lAtti f\
Sworn to(or affirmed)and subscribed before me this Sworn to .a rmed)and subscribed before me this
day of , 20 ,by day of , {/r20 a Q ,by
frt
(Name of person making statement) person Imakng t •�� �� ��
Alkfa.0 r A.( ,t
(Signature of Notary Public-State of Florida) ( ature of Notary P I•lic-State of Florida)
(Print,Type,or Stam mmissloned Name of Nota Public) (Print,Type,or Stam. C/mmissloned Name of Nota ubllc)
Physical Presence OR Online Notarization Physical Presence .v OR Online Notarization f j
Personally Known OR Produced Identification Personally <nown _ OR Produced Identification �rLL((//Ilrr
Type of identification Produced Type of Id o ViroduceWcAN'ammo ,1r
nCommission a cc 0941 1
4
': .,' :'j; '. MYComm.Expiresgpr 0,7021
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