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APPLICATION " CITY OF BOYNTON BEACH, FLORIDA PLANNING & ZONING BOARD SITE PLAN APPROVM. APPLICATION This application must 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 type all information. I. GENERAL INFORMATION 1. ~ML60YNT()J0 G 3q ()c.(1_{l~ Av~ SOl. J\^.ThlA. \3~k . 2.- Date this application is accepted: (to be filled out by planning Department) Project Name: 3. Applicant'S name (Person or business entity in whose name this application is made): 'RA.U ~ t3DymorJ ".- -Address: ---J?(,l) l.}oolbyd'p Q& ~o'" (3rl, 7go- - (10 ~'Z. (Zip Code) Phone: FAX: Phone: Name (Person, if any, representing _~lAAY S\GtJ ~ ~ 8' & 0 S \..) 'd-v-O. St-. D~\,c>,V\ Bct\ \ . d.-18 q :t~1 FAX: applicant) : .-4:,:.: ' ,'Agent' s ..-..... ." ....... . ~~. ~ . -- - .--_: Address: '3s44 S-- (Zip Code) 5 . ProPerty Owner's (or Trustee's) Name: GQ.V\(J ~ ~t DOr e..., Address: 6 ~ q 0 C-c>... D- V- ~ 0 fL, il..Yo~ e()!~", (3c ~ - 1?L Z-i l-~ FAX: (Zip Code) 6.- " Correspondence address (if different than applicant or agent)*: * This is the address to which all agendas, letters, and other materials will be mailed. PLANNING DEPARTMENT - January 1991 A:sitePlan ( 2 ) 7. What is applicant's interest in the premises affected? (OWner, buyer, lessee, builder, developer, contract purchaser, etc.) --1.e....'\ tQ. <2...- 8. street address or location of site: b3q OrQo\""" Au~ tJb~ v/9. Legal description of site and property control *: -+ '-~""~ +-,_0vv~~O,\. ~.1. t~.-O ~'__. tMJ:) ~, - '-t.~. \ 0(;" L'~ -l.\: 3 - l.\-)~ ~\ - S-u - Qed - \0 b 0 10. Intended use(s) of site: 3A~X- LoeA1'jol\) 11. Developer or builder: 12. Architect: 13. Landscape Architect: 14. site Planner: 15. Engineer: 16. Surveyor: 17. Traffic Engineer: approved l~ proposed by the City 18. Has a site plan been previously Commission for this property? 19. Estimated construction costs of this site plan: improvements shown 0: PLANNING DEPARTMENT - January 1991 A:sitePlan ( 9 ) IV. MISCELLANEOUS The following materials must be submitted in one (1) copy: (check) 1. A check, payable to the city of Boynton Beach, as per th~ attached fee schedule. 2. Any other engineering and/or technical data, as may be required by the Technical Review Board to determine compliance with the provisions of the City's Code of Ordinances. V. CERTIFICATION (I) (We) understand that this application and all papers and plans submitted herewith become a part of the permanent records of the Planning and Zoning Board. (I) (We) hereby certify that the above statements and any statemen~s or showings in any papers or plans submitted herewith are true t< the best of (my) (our) knowledge and belief. This applicatio: will / e ?1acce~t d unless signed according to the in ~cti~b 0 . '11'/ 7;~-#1 / / f/l,-jYI 'Signature of Owner(s) or Trustee, Date of Authorized Principal if property is owned b a corporation or other b ss nit. --/ P t,\"C ~ IlS't\ l \1. ~/'~L~' VI. AUT ( e). her~eY 'gna te the above o y aut~ gent in regard to // ~/L-7/ / / ignature of OWner (s) or Trustee, ;f~or Authorized Principal if property is owned by a corporation or other business entity. signed person ~s (my) this applicati~n. ~///,/~/ Date SPACE BELOW THIS LINE FOR OFFICE USE ONLY Review Schedule: Da te Recei -.;ed Date Date Date Date Technical Review Board Planning & Zoning Board Community Appearance Board City Commission Stipulations of Final Approval: Other Government Agencies/Persons to be contacted: Additional Remarks: PLANNING DEPARTMENT - JANUARY 1991 A:sitePlan RIDER TO SITE PLAN APPLICATION The undersigned as applicant for Final 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 aspects of the proposed project 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 acknowledges that the City of Boynton has all rights and remedies as provided by the applicable codes and ordinances of the city of Boynton Beach to bring any violation into compliance, and that in the event of enforcement action by the City, the applicant shall indemnify, reimburse and save the City of Boynton Beach harmless from any costs, expense, claim, liability or any action which may arise due to their enforcement of the same. READ, ACKNOWLEDGED AND AGREED TO THI S \ (~ DAY OF o..~ ~~ , 19 <11-. ""'\ -\"r~ ~~j, ~";hQ ~.,( l~~' ~~~ ,,~~) "tffICIAL *lTAAY SEAL" r"'~r w. C<JlEW() I<<)f AIr( ll\IlUC ST It. 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