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APPLICATION City APPROVAL APPLICATION : . Beach, Florida ning and Zoning Board ',# . This application rnu t be filled out completely and accurately and submitted in one (1) copy to the Planning Department. Incomplete applications will ,not be processed. Please Print Legibly or ype all Information. I. GENERAL INFORMATION '. 1. Project Name: l-cL ~LGroV~ 2. Date this Applicati n is Accepted : (to be filled out b planning Dept.) 3. Applicant's Name (p rson or business application is made : Q+o.--+ I~I 1> entity in whose name this , - :-e.. .s T 's,-f StreeJ M-v<\ OeQ --=r- \, S 'l ~ S'l / [1 3:JLfn - ,.' ...., . .... Address: , Phone: 4. Agent's Name Address: 33 35 ' Phone: , 5. Property Owner's ( '. Name: Address: ofT\.~ c" s;" Cl ~\ aJ t Of\ A- -tt- ~ro It.-I. ' 3~YOCj Phone: 6. Correspondence Ad ress (if different than applicant~agent) * . . * This is the ddress to which all agendas, letters, and other materi ls will be mailed. Planning Dept. 10/8 ''''-., ", " Page 2 7. What'is applicant's i C'u ~ " in the premises affected? CAtrDctc 9. (dwner, Buyer, ~ ssee, Builder, Developer, Contract purchas r, etc.) 8. street Address 'rl (pm tion of Site: 'Lf:- taAd ',- Control #: ~ I a ~ l-o.. LOren c..e .ff rD V~ PI at- On~ .. . 10. Intended Use(s) of SOte: s~te_ - -+'CUy" ''j ~br(1{'..s 11. Developer or Builder K.. +b\JrlCt(\~ Ctt\ Co0'\PQJII C..s 'D ' t= \0 r \60. --r e.. 12. 13. 14. 15. 16. 17. 18. . ' Architect: Landscape Architect: ' Site Planner: Engineer: Surveyor: Traffic Engineer: Has a site plan beGn previously approv~d for this property? . by the City council 19. Estimated constructi this site plan: $ propo~;,'d impl:ovemar. ts sho\.m on .CO Planning Dept. 10/82 IV.' MISCELLANEOUS Page 9 (check) , ()ft/ 1 . The following m must be.~submitted in one (1) copy: A check, payabl to the City of. Boynton Beach, as per the attached fee sch dule. '~I 2. For projects th t generate at least three thousand (3,000)' vehicle trips p r day or two hundred and fifty (250) single directional veh cle trips in a one (1) hour period, a traffic i4..,~~~t 'Cl''''44::'~i ~~.:; :u~~t be =~=i ttod. 3. Any other engin ering and/or technical data, as may be re- quired by the T chnical Review Board to determine compliance with the provis ons of the City's Code of Ordinances. V. CERTIFICATION ,. (I) (We) understa d that this application and all papers and plans submitted h ewith become a part of the permanent records of the Planning a Zoning Board. (I) (We) hereby certify that the above stateme ts and any statements or showings in any papers or plans submitte herewith are true to the best of (my) (our) knowled e and bel ef. This application will not be accepted unle Signed~c/ ,r~tg _to the instructions below. _ ~c '-1, ~, . L-c . r1/a7!@ 1 gnature 0 Owne ~ or Trustee, Date or Authorized Pri cipal if property is owned by a cor oration or other business entity. VI. <--'Y' Agent ~tk1Y'1 (I) (We) hereby designate the above signed person as (my) (OUr~~horiz~ ~en in regard to this application. ~I~~t~~) /' ~/{)1/81 SJ.gnature of Owne (s) 0 Trustee, . Date or Authorized PrO cipal if property is owned by a co poration or other bus ines s e,n ti ty . LOW THIS LINE FOR OFFICE USE ONLY Review Schedule: Date Received: Technical Revi Board Planning & Zon' 9 Board Community Appe rance Board City Council Stipulations of Final Approval: Date Date Date Date , Other Government Agen ies/Persons to be contacted: Additional Remarks: P1anninq Dept. 10/82