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PERMIT APPLICATIONBP200101 CITY OF BOYNTON BEACH Application Inquiry 7/31/03 11:20:31 Application number ..... : 92 00002804 Application status, date : VOID APPLICATION Property .......... : 654 W OCEAN AVE PCN ............. : 08-43-45-29-01-006-0191 Lot Number ......... : 6/13/03 Zoning ........... : R1A Application type ...... : SA Application date ...... : 7/02/92 Tenant nbr, name ...... : Master plan nbr, revwd by : Estimated valuation .... : Total square footage .... : Public building ...... : NO Work description, qty . . . : Pin number ......... : 8349 SINGLE FAMILY (5.80) S/F - ADDITION-BLANKET 43000 0 BD Press Enter to continue. F3=Exit F5=Land inq F10=Fees F11=Receipts F7=Appl names F12=Cancel FS=Tracking inq F13=Val calcs F9=Bond inquiry F24=More keys BUILDING D E P A R T M E N T Q7_~7_~Oq BU~LDDIG Pgi~4~T APPL~T~ON (PLEASE PRINT) PCN It 0~-~f3-~.2~-el :~ -01~j (Palm Beach Co~ty Property Control ~I) ~er' s N~e Wl~Td Co o City State ~L~- zip ~~ Fee Simple Titleholder's N~e (If other than o~er) Fee Simple Titleholder's Address (If other than o~er's) Contractor's N~e ~ W ~-~ ~U ia O~ Contractor's Address ~~ City State Zip Permit Owner's Phone tl ~37 -6503 Contractor' s Phone Job Address (~5-z~ ~/. C~c~/9~/ AV~ City ~c3 VA2TOA," ~.?L~./qfLI-t Cowry ~ Legal D~Cription ~-A%~ ~7' oF SL~'~ ~D Bonding Company~ Bonding Co. Address City mrchitect/Engineer~ -- Architect/Engineer' s Address Mortgage Lender' s N~e ~ Mortgage Lender's Addr~ (check one) ..~~ ESTI~T~ VALUE OF CONS~UCTION: $ ~ Z, OOO '~ DESCRIPTION OF WO~: ~O ~~ ~DD~/o~ - Appliqatipn is here~y ~d~ to obtain a pe~it to do the work ~d installations as indicated. I certify that no work or installation_ has co~enced prior to the issuance of a pe~it and ~hat all wgrk will be perfo~ed_to_ meet the st~dards of all laws resulatins construction in this jurisdiction. I understand that a separate pe~it ~st be secured for ELEC~IC~ WO~, PL~BING, SIGNS, ~LLS, POOLS, F~ACES, BOIL~S, ~T~, T~, and AIR CO~ITIO~RS, ETC. O~'S ~FIDAVIT: I certify that all the fore~oins info~ation is accurate and that all work will be done in compliance with all applicable Saws resulatins construction and zonins. TWICE FOR INPRO~ TO YOURPROPKRTY. IF YOU ~TOOBT. AIN~INANCING, CONSULT WITHYOUR LENDER OR AN ATTO~I~Y BEFO~ ~CO~DING YOUR NOTICe__.. ~. Property Owmer's orA gemt's Sigmature~ Date STATE OF FLORIDA, COUNTY OF PALM BEACH Th9 foregoing instrument was acknowledged before me this~L~ ~ ~L~. · ~Z (date) by d~C~ k~ C~O©~ . , who is ~ers~nal~y known to_me or who nas p,~oauc~d . c~L ~type of~identification} as identification and who did (did not) take an STATE OF FLORIDA· COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this (date) by · who is ~ersonal~y known to_me or who has produced (type of identification) as identification and who did (did not) take an oath. (SEAL) Signature of person takin~ acknowledgement ~ame of officer taking ac~nowledgement--ty?e~, printed or stampe~ Title or rank Serxal number, if any _ _ (Certificate of Competency Holder) Contractor's State Certification or Registration No. Contractor's Certificate of Competency No. LIABILITY INSURANCE EXPIRATION DATE: WORKERS' COMPENSATION EXPIRATION DATE: APPLICATION APPROVED BY 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 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. NOTE: This permit VOID after 180 DAYS UNLESS the work which it covers has been commenced. Ail 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 ALFrHORIZE VIOLATION OF DEED RESTRICTIONS THIS PERMIT OR PLANS FILING FEE IS NOT REFUNDABLE