APPLICATION
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SITE PLAN APPROVAL APPLICATION
City of Boynton Beach, Florida
Planning and Zoning Board
.
This application must be filled out completely and accurately and
submitted in one (i) copy to the Planning Department. Incomplete
applications will not be processed.
Please print legibly or type all information.
I. GENERAL INFORMATION
1.
Project Name:
( AbP"r"CN
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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):
Address:
D^~IO
v/)~
I '700
f1 . 5"'10/:-0'( II , tV
6~ou P
A1 /) IK, r.. ~ '" ({ ~ lJ A y
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5\r ,'Ii:. (00
. 80CA IG4ro.J. ~'-
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Phone:
75'c'" 'l~r8
Fax:
7. TP r()m~. 3) '" 3 2-
/ yd - troD
4. Agent's Name (person, if any, representing applicant) :
:5'/-C A-;6 " s/ t:...
Address:
ZIP CODE:
Phone: Fax:
5. Property Owner's (or Trustee's) Name:
V.16 I l,'I"t?
,
Address:
/00 P t. 7,(/J
fr {"Av.1f;(PAt-~
7t J,. 1.1 " to
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Phone:
Fax:
ZIP CODE: JJ 36/
7Co - 7Yzr
6. . Correspondence address (if 'different than applicant or
I
agent)*:
* This is the address to which all agendas,
letters,'and other materials will be mailed.
Planning Dept. 3/90
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Page 2
7. What is applicant's interest in the premises affected?
(Owner, buyer, lessee, builder, developer, contract purchaser,
etc.) DE..tJc<,P~ .r f\~t..;.j" Fo,l.. OvJN€.IL
8. Street address or location of site:
22<10
N
(!CN(-~f"F J'
9. Legal description of site and property control #:
ht~-,'ory C~"v:rI!(J' #" 08 - 'r,J - .yf'" - 17 - (1~ - ooy - oosC:
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10. Intended use(s) of site:
S~E..-
11. Developer or builder:
f/~
b,Le<.J I' JPG
12. Architect:
13. Landscape Architect:
14. Site Planner:
15. Engineer:
16. Surveyor:
17. Traffic Engineer:
18. Has a site plan been previously approved by the City
Commission for this property? V~ r
(
19. Estimated construction costs of proposed improvements shown on
this site plan: ~r6;~oe
Planning Dept. 3/90
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Page 9
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IV. MISCELLANEOUS
(check)
/
/
The following materials must be submitted in one (1) copy:
1.
A check, payable to the City of Boynton Beach, as per
the 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 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 tions below.
VI.
Owner(s) or Trustee,
Principal if property
corporation or other
ty.
/.;J-;;%q 0
I ate
Agent
/~h~
"Date
I
,
ereby designate the above signed person as (my)
H rized agent in regard to this application.
Owner(s) or Trustee,
d Principal if property
a corporation or other
itY.i
SPACE BELOW THIS LINE FOR OFFICE USE ONLY
, i~/I~/9t>
~ Date
Review Schedule:
Date Received:
Technical Review Board
Planning & Zoning Board
Community Appearance Board
City Cormnission
stipulations of Final Approval:
Date
. Date
, Date
Date
Other Government Agencies/Persons to be contacted:
Additional Remarks:
Planning Dept. 3/90
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!I The undersigned as applicant for Final Site Plan
~~pproval does hereby acknowledge, represent and agree that
:all plans, specifications, drawings, engineering, and other
:pata submitted with this application for review by the City
,of Boynton Beach shall be reviewed by the various boards,
!Fommissions, staff personnel and other parties designated,
.appointed or employed by the ~ity of Boynton Beach, and any
lsuch party reviewing the same shall rely upon the accuracy
ithereof, and any change in any item submitted shall be
"
.qeemed material and substantial.
RIDER TO SITE PLAN APPLICATION
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II The undersigned hereby agrees that all aspects of the
!proposed project shall be constructed in strict compliance
iwith the form in which they are approved, and any change to
it-he same shall be deemed m~terial and shall place the
applicant in violation of this application and all approvals
and permits which may be granted.
II The applicant acknowledges that the City of Boynton has
IFll rights and remedies as provided for by the applicable
codes and ordinances of the City of Boynton Beach to bring
~ny violation into compliance, and that in the event of
knforcment action by the Ci ty, the applicant shall
~ndemnify, reimburse and save the City of Boynton Beach
rarmless from any costs, expense, claim, liability or any
laction which may arise due to their enforcement of the same.
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READ, ACKNOWLEDGED AND AGREED TO THIS IZ DAY OF
lEe ~~.I' , 19~.
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