PERMITWARNING TO OWNER: 0
"YOUR FAILURE TO RECORD A NOTICE OF COM- CITY OFBOYNTONBEACH
MENCEMENT MAY RESULT IN YOUR PAYING TWICE BUILDING DIVISION
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANC-
ING, CONSULT WITH YOUR LENDER,,OR AN ATTORNEY BEFORE RECORDING
YOL~R~Oq'ICE OF COMMENCEMENT.
Date Applied:
NOTICE
I IN ADDmoN TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE Prepared By:
I TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY AND THERE MAY
IBE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
IDISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Date Issued:
Permit Type:
BUiLDiNG PERMIT
INSPECTIONS ARE REQUIRED: SEE BACK OF PERMIT
Twnshp. ~t Sub Dvsn.
Property Address
!'! FENWICK PL
GUIFARROC
Permit No.: 0Z000015,~5
CARD FOR REQUIRED INSPECTION,
Block Lo~ Plat/Book/Page
0~'4 .-.-~... T .--.
Zoning Reviewed by
RA
Owner's Name/~dmss/~lep~ne
u~R~S, ~WA~D D & AGNES C
'!! FENWICK PL
LAKE WORTH FL 33~6Z
Additional Description
~LATH AND STUCCO
Construction J BFE
Sq. Ft.
Schedule of Fees
FFE FLZ
Valuation
Legal Address
BOYNTON LAKES FL Z
Contractor's Name/Address/License/Telephone
BURNS, HOWARD D & AGNES C
!i FENWICK PL
LAKE WORTH
FL '33~62
General/Architect/Engineer
Improvements
OTHER FEES:
AUTHORIZED SIGNATURE ~.~' ~
'OT~- · _ ...................
THIS PERMIT SHALL BECOME NULL AND VOID UNLESS THE WORK AUTHORIZED IS COMMENCED WITHIN CE, OR
IF THE WORK AUTHORIZED HAS NOT RECEIVED AN APPROVED INSPECTION FOR A PERIOD OF ONE HUNDRED AND EIGHTY (180) DAYS.
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 the granting of 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,
Florida. This permit fee is not refundable.
City of Boynton Beach
Building Division
02-t545
OWNER/BUILDER AFFIDAVIT
Permit Application No. 0~)~/b~. Owner: ½0(~,~Ct ,~ (_.L~ n~
i hereby apply for a Building Permit in the City of Boynton Beach, Florida, and will personally supervise and
control the permitted construction and will observe all the requirements of the Building, Electrical, Plumbing,
Mechanical, Zoning and other technical codes as adopted and enforced by the City of Boynton Beach.
WHEN ISSUED, I UNDERSTAND THAT THIS PERMIT IS FOR CONSTRUCTION OF IMPROVEMENTS
EXEMPT UNDER 489.103 (7) OF THE FLORIDA STATUTES, AND CERTIFY THAT I AM THE BONA FIDE
OWNER OF SAID PROPERTY. I ALSO UNDERSTAND THAT:
State law requires construction to be performed by licensed contractors. I have applied for a permit under an
exemption to that law. The exemption allows me, as the owner of my property, to act as my own contractor
with certain restrictions even though I do not have a license. I must supervise the construction myself. I may
build or improve a one-family or two-family residence, or a farm outbuilding. The building must be for my own
use and occupancy. It may not be built or substantially improved for sale or lease. If I sefl or lease a building I
have built or substantially improved myself within 1 year after the construction is complete, the law will
presume that I built or substantially improved it for sale or lease, which is a violation of this exemption. I may
not hire an unlicensed person as my contractor. My construction must be done according to building codes
and zoning regulations. It is my responsibility to make sure that people employed by me have licenses
required by state law and by county or municipal ficensing ordinances.
I certify that I have not completed a residence or duplex under an owner-builder permit within the past
twelve (12) months.
I, THE OWN~ ~F ~,)~OPE~T~ES~IBE~/~((~,,~ description) ~¢~l~_~v~/~'~0~ ....... / (~ ~?(~
(Address) '- i i ('i1%--.VI.DO HEREBY CERTIFY THAT I HAVE READ
THE FOREGOING, AND AM AWARE OF MY RESPONSIBILITIES AND LIABILITIES FOR
CONSTRUCTION WORK ON THE ABOVE DESCRIBED PROPERTY AND DO HEREBY COVENANT AND
AGREE TO ABIDE BY ALL OF THE AFORESAID STIPULATIONS. I FURTHER UNDERSTAND THAT ANY
FALSIFICATION OF THE ABOVE STATEMENTS CONSTITUTES FRAUD AND MAY RESULT IN
CANCELLATION OF THIS PERMIT AND THE IMPOSITION OF OTHER PENALTIES AS PRESCRIBED BY
Owner Date
The foregoing instrument was acknowledged before ~e this ~--~~ate) ~
who is personally known to me or ~d ~~ ~~ ~~- (ty.o of idontificat,on)
as identification and who did (did not) take an oath.
~SEAL~ ~ Co~missi~ C~
~lgna[urm~person [eKing acKnowleogment ~
Name of officer taking acknowledgment- typed, printed or stamPe~
Title
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561) 742-6350 Fax: (561) 742-6357
S.'~,Development~Forms& TemplateslOwner-Builder Affidavit (Rev. 2-02)