PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
12/09/02
09:58:07
Application number ..... : 02 00001418
Application status, date : FINALED
Property .......... : 301 N CONGRESS AVE
PCN ............. : 08-43-45-30-01-001-0012
Lot Number ......... :
6/07/02
Zoning ........... : C3 COMMUNITY COMMERCIAL
Application type ...... : S SIGN
Application date ...... : 4/18/02
Tenant nbr, name ...... : SOUTH FACE
Master plan nbr, revwd by : BD
Estimated valuation .... : 550
Total square footage .... : 0
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 2408
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Ue.rAt(l~VlE~ 1' OF' DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
(Please Print)
COMPLETE EACH BOXED ENTRY Permit #
02- 141'8
(FOR SUB PER~[ITS ONLY')
PCN# O~'--q 3- '45-- 30-01-O0G-o~13_
Owner's Name~ /~o3[;v~, i;~.'~,,/
Owner's Address~
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address
Contractor's Compan~ ~~
[Contact person and emergency
Company Address
C~ty ~o I1~ ~
egal Description~
(Palm Beach County P~roperty CF~ro~,#)
[Owner's Phone ~ ~ ~/$ ~] --~4~
Zip ;7 7ob 7
(If other than owner's)
.(If other than owner's)
Pager/Fax# (9.,'~/) q~ I- 7q$¢1
~'/. . Zip , ~
Bonding Company /V/,,~
Bonding Co. Address City
ArchitectJEngineer's Name
Architect/Engineer's Address 1 ~ f~,..
Mortgage Lender's Name J,(J [/~
Mortgage Lender's Address
SINGLE FAMILY __ DUPLEX MULTI-FAMILY
check one)
ESTIMATED VALUE OF CONSTRUCTIONI $
DETAILED DESCRIPTION OF WORK:I ~,,,~-/,~//~,~,~.
CHECK REVIEWER REQUIRED: '
Zoned
.' State
HOTEL~ RETAIL /~ OFFICE INDUSTRIAL
Application is hereby required to obtain a permit to do work and installations as indicated. I ce~Tfy t-hat-~O-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 codes, laws, rules and
regulations governing construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL~, PLUMBING,
SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS AND AIR CONDITIONING WORK, 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
codes, laws, rules and regulations governing construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TVVICE FOR IMPROVEMENTS TO YOUR PROPERTY, IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Property Owner's or Agent's Signature Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before mc this
who is personally known to mc or who has produced
take an oath.
(SEAL)
/
Signature o f person taking acknowl¢fi"ffeme
printed or ure
stamped Title or rank
Contractor's Signat
STATE OF FLORIDA, M BEACH
The foregoing instrumen ~as ackno~oledged before m~this
who is ~ly known to me or~w~l has produced
take an oath.
(SEAL)
SignatUre of person taking acknowledgement
printed or stamped
(date) by
identification and who did (did not)
Name of officer taking acknowledgement- typed,
Serial Number. if any
'o,,.
a~ b~~ ' .......... / i /
CF'~ '?~ MYCOMMISSION#~028225 ~
/~ officer taking acknowledgement - typed,
· ~itle or r~k Serial Number, if any
Contractor's State Certification of Registration No.
Liability Insurance Expiration Date
Workers' Compensation Expiration Date
Application Approved By
(Certificate of Competency Holder)
Permit Officer Date:
Any change in building plans or specifications must be recorded with this office. Any work not covered above must have a valid permit prior
to starting. In consideration of granting this permit, the owner and builder agree to erect this structure in full compliance with the Building
and Zoning Codes of the City of Boynton Beach.
NOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has commenced. All Contractors must have
valid State Certification or County Competency plus'County and City Occupational Licenses prior to obtaining permit.
ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS
FEES ARE NOT REFUNDABLE
S:\DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION MOD.A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000