APPLICATION
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SITE PLAN APPROVAL APPLICATION
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City of Boynton Beach, Florida
Planning and Zoning Board
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. 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. projec~.Name:
Bethesda Professional Plaza
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2. Date this Application is Accepted :
(to be filled out by Planning Dept.)
3. Applicant's Name (person or business entity in whose name this
application is made) :
.. .. .... . Bethesda Health Care Corporation
Address: 2815 South Seacrest.Bou1evard
Boynton Beach, Florida 33435
Phone:
407-737-7723
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Agent's Name (person, ~f any, representing applicant):
John Campbell - Universal Medical Bui1dinqs
Address:
839 North Jefferson Street
Milwaukee, Wisconsin 53202
Phone:
414-278-0100
s. Property Owner's (or Trustee's) Name:
Address:
Bethesda Health Carp rnrpnr~tinn
2815 South Seacrest
Boynton Beach,' Florida 33435
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Phone:
407-737-7723
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6. Correspondence Address (if different than applicant or agent)
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* This is the address to which all agendas,. letters, and
other materials will be mailed.
Planning Dept. 10/82
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7. ~Wha~ is applicant's' interest in the premises affected?
Property Owner
(Owner, Buyer, ~essee, Builder, Developer,
Contract Purchaser, etc.)
8. street Address or Location of Site:
2623 South Seacrest Boulevard
Boynton Beach, Florida 33435
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9.
Legal Description of Site/property control fi:
Lots 8-9, Pinecrest Ridge, PB 24, PG 153,
Palm Beach Country, Florida
Lease Recorded in or Book .5415, Page 304 (9/10/87)
Notice of Commencement O/R Book & Page: 5364/ 724
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10. Intended Use(s) of Site: Office Building
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11. Developer or Builder. Universal Medical Buildings
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~..~~ Architect..
~ Universal Medical Buildinqs
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13. Landscape Architect:
14. Site Planner:
15. Engineer:
16. Surveyor:
17. Traffic Engineer:
Universal Medical BUildings
Universal Medical Buildinqs
Universal Medical Buildings
Richard Shephard & Associates
Universal Medical Buildings
18. Has a site plan been previously approv~d by the city councii
for this propel.ty? ___ Yes _____. u_.... .___________.._
19. Estimated construction cost of propo:Hlll ili\pl'ovem~r,ts sho\.Jn on
lhis site plan: $1,500.00
Planning Dept. 10/82
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IV.' MISCELLANEO~S
The followlng~~aterials must be submitted inf~ne (1) copy:
A check, payaple to the City of Boynton BeaCh~C.fRB/2~.,QNBHe~uciI6N
attached, fee .schedule. $200,00 U
. (c~leck}
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,JAN 24 1,qA~
2.
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For projects that generate at least three th~.;s-and- (3,000) ---:-
vehicle trips per day or two hundred and fi -(.2.S0L.single.-........
directional vehicle trips in a one (1) hour er-.iod.,_a traffic-
.. . . _ .... .... _ ~ .._ _ , .. _.. _ A.. \........ _..\....___".4. ....""~ . ~..r"I.":W-"_"~~~"",.,,,,,,,___
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3. Any other engineering and/or technical data, as may be re-
quired 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 statements or showings in anY.papers
or plans submitted herewithare.true to the best of (my) (our)
knowledge and belief. This application will not be accepted
unless signed according to th~ instructions below.
S gnatur of ner(s) or Trustee,
or Authorized Principal if property
is owned by a corporation oi~ other
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business entity.
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I Date
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Agent
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Date
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(I) (We) hereby designate the above signed person as (my)
(our) authorized agent in regard to this application.
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Signature 0 wner(s) or Trustee, . Date
or Authorized Principal if property
is owned by a corporation or other
business e?tity.
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SPACE BELOW THIS LINE FOR OFFICE USE ONLY
Review Schedule:
Date Received:
Technical Review Board
Planning & Zoning Board
Community Appearance Board
City Council
Stipulations of Final Approval:
Date
Date
Date
Date
Other Government Agencies/Persons to be contacted:
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Additional Remarks:
Pl~nning Dept. 10/82
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Signed, sealed and delivered
in the presence of:
BETHESDA BUILDING PARTNERSHIP,
a Florida general partnership,
by its general partner,
BETHESDA MEDICAL BUILDINGS,
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By:
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STATE OF FLORIDA
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COUNTY OF PALM BEACH
Before me personally appeared to
me well known to be the individual(s) described in and who
executed the foregoing instrument as President of the above-named
. BETHESDA MEMORIAL HOSPITAL, INC., a corporation, and acknowledged
to and before me that he executed such an instrument as such
President of said Corporation, and that the seal affixed to the
.foregoing instrument is the corporate seal of the corporatio~,
and that it was affixed to the foregoing instrument by due and
regular corporate authority, and that said instrument is the free
act and deed of said Corporation.
WITNESS my hand ~nd officjal seal, this.
, 1987.
day of
Notary Public
. , My. Commiss ion Expir.es:
STATE OF FLORIDA
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COUNTY OF.' PALM BEACH
I HEREBY CERTIFY that on'this day, before me-an officer duly
authorized in the State aforesaid and in the County aforesaid to
take acknowledgements, personally appeared'
, the President of BETHESDA
MEDICAL BUILDINGS, INC., general partner of BETHESDA BUILDING
PARTNERSHIP, a Florida general partnership, to me known to be the
person described in and who executed the foregoing instrument and
acknowledged before me that he executed the sam~.
WITNESS my hand and official seal in the County and State
last aforesaid this ____ day of , 1987.
Notary Public
My Commission Expires:
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