APPLICATION
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APPLICATION/
AUTHORIZA TIO N
BUILDOO PIIMIT APPLICATI(Jf
(PLEASE PRINT) Permit #
PCN II ._ ?;J - (J('JOZ) (POI SUB PIRKITS ONL
(Palm Beach County P~operty Control #) ;2
Owner's Name Howard R, Scharlin. Katcher. Scharlin & T.~n?etQwner's Phone H 407-241-3225
Owner's Address United National Bank Building, 4th Floor. 1399 S,W. 1st Ave..
City Miami
State Florida Zip 33130
Fee Simple Titleholder's Name
aUI LOING
OEPAATMEN T
{(?- ;7;1
=
(If other than owner)
Fee Simple Titleholder's Address
(If other than owner's)
Contractor's Name OUT TO BID = Smoak & Foster. Inc .Contractor I s Phone 11813-367-2592
Contract()'r's Ad~ress P. O. Box 67184
City St. Petersburq Beach
State_..F.lor.ida___ __ Zip_ JJ1J6.
Job Name Racetrac Pe
Job Address N.W. corne
City Bovnton Beach Palm Re.ac.h
Legal Description Portion of Tract B, Shoppes of Woolbri~ht P,C.D.. recorded in Plat
Rook nl)t P~iP~ 1~7 & l1R, p~lrn 'Rp.Qrh t:nllnry
Bonding Company
Bonding Co,Address City
Architect/Engineer's Name Philio Windsor
Architect/Engineer's Address 6679 Jimm' Carter Blvd.
Mortgage Lender's Name N/A
Mortgage Lender's Address N A
SINGLE FAMILY: DUPLEX: MULTI-FAMILY: HOTEL:
(check one)--- --- ---
ESTIMATED VALUE 01 CONSTRUCTION: $500,000,00
DESCRIPTION OF WORK: Construct a convenience ~tore with
State
Application is hereby made to obtain a permit to do the work and
certify that no work or in.tallation has commenced prior to the iss it and that
all work will be performed to meet the standards of all laws regulatin ction in this
Jurisdiction, I understand that a se~~rate p~~it must be secured for ELECTRICAL WORK,
PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANIS, and AIR CONDITIONERS, ETC.
OWNER'S AFFIDAVITl I certify that all the fo~egoing information is accurate and that all worl
will be done in compliance with all applicable laws regulating construction and zoning.
W~ TO 0WNIIl: YOOI rAn11RJ to IJCt~D A I<<1fICI 0' <XIICDCIMIRT KAY IlSULT IN YOOI PAYING
TWICE POi lJtPIOV1lMIM'J. TO YOOI PIOPaTY. U too Dft'INI) TO OBTAD rDWICDiG, <niSULT WITH yOU]
L.RHDIR OR AH ArraRNIY BDUm 1JC(m)x.;~TICI or ~r.
Pro~~y Owner'. or ~t'~.,~ipa~ Date -'/ - 3l' -93
STATE OF FLORIDA, COUNTY OF 'ktJI BMt1l1f \ (;u' e..
The forego ng in4trument was acknowledged before me this .4- ,3l7 - 93 (date) by
. :~ld /-~ , who is ersonal y known tome !I ~~a3 prOdUCed
tiga--e--- d who did did not) take
'+-~~" D/~ IlOTl'lRY PUBL TC STATE OF FLORIi)!
MY COMMISSION EXP. JULY 4,199/
(SEAL) " .,. NOTARY BOilOEO THRU GENERAL INS. UNO.
Signature of person tlking acknowledgement t,Ll~:L, sue
Name of officer taking acinowledgement.-t~e , pr n e or
Title or rank Seral number, if any ~ \'
Contractor's Sipature 9-c-. '-- --:>. ~J3A l~ Date ~.t:t.<=t?
STATE OF FLORIDA. COUNTY OF l'JItI. ~.; .~, II" 5 , . .
The foresoinL instt"UllHlnt wa. acknowledged before me this /flk Ie 11 l 2- 19 (I 5 (date) by
&-u'1'~."L.J 1LI..f~" 5,.-. , who is Qersonally known to me or wno nas pro(1uct}<1
- --.--.------- (t.ype of identification) as identification and who did (did not) take
om,
oatn,
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(:)!.AL) Ih
Signature of person taking acknowledlement ~/
Name of officer taking acinowledgement--t e, pr n e s
Tttle ,~r rank Serlll number, if any
(Certificate of Competency Holder)
Contractor's State Certification o~ R6gistration No, CGC044~~~
Contractor's Certificate of Competency No.
LIABILILi INSlTRANCE EXPIRATION DATE: 11/07/93
WORKERS' COMPENSATION EXPIRATION DATE; 03/01./94
APPLICATION APPROVED BY
',',I,'
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Permit Officer
Date:
Any change in building plans or specifications must be recorded with this office. Any ~ork r
choviered above mUle have a valid permit prior ~o itartini' In ~OnSiQ8ration of the itantlni 01
Bt ,5 permit, the owner and builder agree to erect this structure in full compliance with the
ulldlng and Zoning Codes of the City of Boynton Beach.
NOTE: This permit VOIn after 180 DAYS UNLESS the work which it covers has been commenced.
OContrac~ors must have valid State Certification or County Competency plus County and City
ccupatlonal Licenses prior to obtaining permit.
ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF OEED RESTRICTIONS/f7;
THIS PERHIT_~R P~~S_FILING FEE IS ~OT REFUNDABLE ~
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