Application Form-2025.09.6138Proj ect/Case #
20 25 .0 9.61 38
Addre ss:
3 20 0 OLD BOYNTON R D, Boynton Beach, FL 33 43 6
MINOR DEVELOPMENT
APPLICATION FORM
Pre-Applic ation Details / Projec t Information
Address
Parcel
Project
Number
S ubmiss ion
D ate
Project
Coordinator
Minor Land Dev elopment Applic ation Ty pe
Adminis trative
Adjustment
Administrative
W aiver
Certificate of
Conf ormity
Lot Line
Modif ic ation
Minor Mas ter Plan
Modif ic ation
Minor Site Plan
Modif ic ation
Minor S ite Plan
Modification
(Architectural /
Elevation
Changes )
Minor Site Plan
Modif ic ation
(Repaint)
Mobile Vending
Unit
New Minor S ite
Plan
S idewalk Cafe S ign Program
S ign Program
Amendment
Site Plan T ime
Extens ion
Projec t/C as e Name 2024.07.61326
Estimated C onstruc tion V alue
Parc el Siz e 32.5826 ac res
Total Square Footage
Des cription of
Ex isting U se(s ) of
Property Site
Retail - Existing land use com
Desc ription of
Propos ed U se(s ) of
Property Site
Retail - Existing land use com
Prev ious Site
A pprov al on Subjec t
Property
No Yes
Is the propos ed use
eligible for the C ity ’s
Ex pedited
Dev elopment Rev iew
Program purs uant to
C hapter 2, A rticle I,
Section 5 of the Land
Dev elopment
Regulations ?
No Yes
Indicate the proposed
use(s ) and/or
des cribe the project's
c haracteristics that
av ails its elf the
opportunity f or
Program Eligibility
Ex is ting Land U se
C lass if ic ation
Local Retail Commercia l (LRC)
Propos ed Land U s e
C lass if ic ation
Loca l Reta il Commercial (LRC)
Ex isting Zoning
Designation
C3 Community Commercia l
Propos ed Zoning
Designation
C3 Community Commercia l
Is the property
located w ithin the
C ommunity
Redev elopment
Areas (C RA)
No
Lis ted in the C ity 's
Inv entory of Historic
Sites
No Yes
Will the applicant be the primary point of contact?
Y es No
A pplicant Information
First Name Jacquie Las t Name Pedevillano
C ompany Name Bowman Consulting
Street A ddress
4450 W Eau Gallie Blvd
S uite 144
C ity Melbourne
State Florida Zip 32934
Phone #3215439247 Email BowmanEV_Melb@bowman.com
Interes t in Property Owner Less ee Contract Purc haser
Property Ow ner (Trus tee) Inf ormation
S ame as Applic ant
Firs t Name John Las t Name D avis
C ompany Name
WAL MART S T ORES EAST
L P
Street Addres s PO BOX 8050 C ity Bentonville
State Arkansas Zip 72712
Phone #3215439247 Email john.davis1@walmart.com
A gent Information
All correspondence will be emailed to the agent unless there I no agent of record, in which case, all correspondence will be emailed to the applicant. This
party will receive agendas, letters, and other materials.
S ame as Applic ant
First Name Jacquie Las t Name Pedevillano
C ompany Name Bowman Consulting
Street A ddress
4450 W Eau Gallie Blvd
S uite 144
C ity Melbourne
State Florida Zip 32934
Phone #3215439247 Email BowmanEV_Melb@bowman.com
A uthoriz ation of Agent
Signature of Ow ner or A gent 1 Jacquie Pedevillano Signature of Ow ner or Agent 2
Date 1 09/23/2025 Date 2
C ertification
(I) (W e) understand that this application and all papers and plans submitted herewith become part of the permanent records of the planning
and zoning division. (I) (W e) hereby certify that the above statements or showings in any papers or plans submitted herewith are true to the
best of (my) (our) knowledge and belief. This application will not be accepted unless signed according to the instructions below.
Signature of Ow ner(s ) or
Trus tee(s ), or authoriz ed principal if
property is ow ned by a corporation
or other business entity , or contrac t
purchas er (if applicant).
Jacquie Pedevillano Date of A uthoriz ed A gent Signature 09/23/2025
Rider to the Site Plan Applic ation
The undersigned as applicant for site plan approval does hereby acknowledge, represent, and agree that all plans, specifications, drawings,
engineering, and other data submitted with this application for review by the City of Boynton beach shall be reviewed by the various boards,
commissions, staff personnel, and other parties designated, appointed, or employed by the City of Boynton beach, and any such party
reviewing the same shall rely upon the accuracy thereof, and any change in any item submitted shall be deemed material and substantial.
The undersigned hereby agrees that all plans, specifications, drawings, engineering, and other data that may be approved by the City of
Boynton Beach, or its boards, commissions, staff, or designees shall be constructed in strict compliance with the form in which they are
approved, and any change to the same shall be deemed material and shall place the applicant in violation of this application and all approvals
and permits which may be granted.
The applicant agrees to allow the City of Boynton Beach all rights and remedies as provided for by the applicable codes and ordinances of
the City of Boynton Beach to bring any violation into compliance, and the applicant shall indemnify, reimburse, and save the City of Boynton
Beach harmless from any cost, expense, claim, liability, or any action which may arise due to their enforcement of the same.
A representative must be present at all Development Application Review Team (DART) meetings.
Read, Ac know ledged, and A greed No Y es
A pplication Rider A pplicant Signature Jacquie Pedevillano A pplication Rider Witnes s Signature