PERMIT DOCUMENTS
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UNIVERSAL COUNTY-WIDE/MUNICIPAL
FBC Version:______________ Permit Type: _______________
BUILDING PERMIT APPLICATION FORM
Accepted By:____________ Application Date: _____________
January 2020 Edition
Application #:________________________________________
Approved for use throughout Palm Beach County and Municipalities
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KIND of PERMIT (CHECK ONE): PROPERTY OWNER:_______________________________________
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PRIMARY PERMIT TENANT:________________________________________________
SUB-PERMIT -If Fee & Value of a Sub-Permit are 231
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ADDRESS: ____________________________________UNIT:______
covered under a Primary Permit, complete boxes 1, 3, 4, 5, 6 &
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CITY: __________________________STATE: ______ZIP:__________
8 only to apply. If not covered under a Primary Permit,
672.515.8147
complete the entire application to apply.
PHONE: __________________________FAX:___________________
PRIVATE PROVIDER: PLAN REVIEW INSPECTIONS
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EMAIL:__________________________________________________
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TRADE (CHECK ONE):
PROJECT NAME: _____________________________________________
STRUCTURAL ROOFING ELECTRICAL
613:1:111
1 945327
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PCN: __ __-__ __-__ __-__ __-__ __-__ __ __-__ __ __ __
MECHANICAL PLUMBING FIRE GAS
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LEGAL DESCRIPTION:__________________________________________
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OTHER: _______________________________
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PROJECT ADDRESS: _____________________________________________
32.2144
PRIMARY PERMIT #: _____________________
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CITY: _______________________________________________________
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FURTHER WORK DESCRIPTION: ____________________________________________________________________________
Type of Work: New Addition Alteration Repair Demo Temporary Other
3-4612:4/4:
(SEE FEE SCHEDULE) (AS APPLIES) (AS APPLIES)
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OWNER BUILDER PER FL. ST. 489 (AS NAMED ABOVE, FOR CONTACT INFORMATION SEE BOX 2)
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CONTRACTOR (CERT. HOLDER): _______________________________________________ License #: ________________________
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DBA (COMPANY NAME): _______________________________________ Contact Person: ________________________________
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ADDRESS: _____________________________________STE:______ CITY: ____________________STATE: ________ ZIP:________
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PHONE: ____________________________ FAX: _______________________ EMAIL: ________________________________________
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.
information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
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________________________________________________________________________________ ________________________________________________________________________________
(Signature of Owner or Agent) (including contractor) (Signature of Contractor)
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Print Name: _______________________________________ Print Name: ________________________________________
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 ________________________________________
Sworn to (or affirmed) and subscribed before me this _______ Sworn to (or affirmed) and subscribed before me this _______
day of __________________, 20 , by day of _____________________, 20_ , by
____________________________________________________ ____________________________________________________
(Name of person making statement) (Name of person making statement)
_________________________________________________ _________________________________________________
(Signature of Notary Public -State of Florida) (Signature of Notary Public -State of Florida)
_________________________________________________ _________________________________________________
(Print, Type, or Stamp Commissioned Name of Notary Public) (Print, Type, or Stamp Commissioned Name of Notary Public)
Physical Presence _____ OR Online Notarization _____ Physical Presence _____ OR Online Notarization _____
Personally Known _____ OR Produced Identification _____ Personally Known _____ OR Produced Identification _____
Type of Identification Produced ______________________________ Type of Identification Produced ______________________________
Page 1 of 2
Correction to application 21-1033
Requested to remove sign on rear of building to allow for proper sizing of sign in front.
US Patent and trademark info attached
And revised sizing to meet 1 inch stand off
4/1/2021, 2:53:51 PM BYB2LJB
REVIEWER: Luis Bencosme
EMAIL: Bencosmel@bbfl.us
Phone: 561-742-6262
PERMIT: 20-1033 Review Cycle: (00), Revision: (00)
ADDRESS: 1000 N Congress Avenue
COMMENTS:
The Boynton Village and Town Center development has an
approved Sign Program. Please make the following corrections
(1) The total allowable wall sign area is calculated asfollows: 1.5 ft. X Building Frontage. The building frontage
of the subject tenant space is 20 feet. Therefore, the
aggregate sign area (both wall signs combined) shall not
exceed 30 square feet. The proposed sign area far exceeds
the allowable sign area. Please reduce the size of both
signs to not exceed a combine area of 30 square feet.
(2) The channel size for channel-mounted signs shall be 4
inches in height and 6" inches in width and painted to match
the building wall.
(3) Please submit documentation from the United StatesPatent and Trademark Office that confirms the proposed sign
font has a trademark. If a trademark does not exist, please
correct the font to Futura Book - Bold or Paletino - Normal,
Bold.
(4) Submit a completed Building Permit Application form.
(5) The stand-off shall not exceed 1 inch.