PERMIT APPLICATION
- DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT REVISION APPLICATION
PLEASE PRINT _ 0 0 - 223
ORIGINAL PERMIT # i DO';}.. ~ ~ ' j _. .'."'., MASTER, ~AN # 'r-'~ .,>' h . _ ,,G_k!.. f(2
PROJECT NAME: Y (" \- CC Cl . A'i(-~ê',K:;¡i> (ADDRESS: ! D (\P _ z - L-¡ -L. '¡:1~_'é I "j;.;(6(
Contractor's Name éJ l)\;-l¡r bl i¡ (r{(:(.., <~ Contractor'~ Phone # '''270 .-?i::cí- ~~'(.i I
TOTAL ESTIMATED VALUE OF THIS REVISION: $ c~:y\.A1.' .
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DES..C. RlPTIO. NO.. F W. ORK.. ..(.. p......I....e.... a.......s...e.....s...p. e....c..i.?.. i~ d..' e. tl...i.' w~ayïs ~. ei.,.n.. f. revise. .. d. 6. r.~.. m. .. or.l.·~.i.nl'.a.... \,¡? .~.~.. '.i:. ~;, _ .'. .. . .. ... . ...... . _ . ,
BU!LDINÇìj___ ,.Rf'z:p,~\.,.,r..'" .¡:r,.'~~:.~~. )¡'.t. ¡()/. \I¡.~/ ~-.,::·I(~t?C~ ¡ V; b.. ,r~~.;.~..r..) ð ~~§Jt\ ru ,-",c1
'\ ,') ..If (1? ¡\...t ~,\¿^,",~C"vy" ·~f~~( l ,~~ ;,Ja,,;tf>ø·""v,',~¡;(J;.. ~.\..) +:,)-.1 ; -rt¡t:,
Value of Work: $ ç:::;;>A/'Ji......e~ . --~ii.fì+(+(,Cc ~ ' eq(...(ef::..--t-.
CLEARING & GRUBBING:
Value of Work: $
DRAiNAGE:
Value of Work: $
ELECTRICAL:
Value of Work: $
EXCAVATION:
Value of Work: $
FILL:
Value of Work: $
FIRE SPRINKLER: I. ~rJ
~..- .........,.
Value of Work: $ \ \'.:;.\ :}' ./7 ~." ...., ..... .....
' : r"'''~ ... . ..
IRRIGATION: ',' \ ~. t"i'f/1 . ,
",.' f', \. . .,'
, ' c:1'" i (".,d'_ " ,'. \
Value of Work: $ .~,._j 1 \ .
LANDSCAPING: ._~.... ':' n;7' OÌ'}j, '\V. \
.:;;.:.-- ~
Value of Work: $
MECHANICAL: .-PC "
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"",'
Value of Work: $ "'. _.V
PAVING: "-,
ç...~-'-
Value of Work: $
P A VING/DRAINAGE:
Value of Work: $
/PLUMBING:
Value of Work: $
RQ9FING: _
Value of Work: $
SIGN:
Value of Work: $
SITE LIGHTING:
Value of Work: $
I wish to revise the above referenced permit to perform the work described herein. I certify that all wo~k will be constructed i
conformance with all laws, COd).S., t'egul,ti ons., ru.le... s, et~.,... ,go.v.e. lJling. Boynton Beach, and I cert.. J.y. t a. t th. ab.o.... ve. information is tru
and correct. f""\ I' .' c '~--Ji ... \';:-/? . . q ,.-.....
Contractor's Signature r l.P !ôYJI/U{, ,. .#,/ (2 (Jl··é,cl date: f!,. V c -
STATE OF FLORIDA, COUNTY OF PALM BEACH _ "-: _ '/ J .. í ,; . ."
Tho '""go;", ;"bu~' _ "koowl,'", b"ore _1h;, 0 »¿;t? ("'~) by ! ØJI?-; /(~t; ~;, .._,lIy ""0_ ~ _ M woo ,
produced (Iype ofidentificationÇ~~dentification and who did (~e an oath, ----
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/ < <:i-;''I- (¡ð.... LYlill ,~"nn Hays : .
(SEAL) . .. ( .. ~¿<, Notary. Public, State of Florida >:
. . - A .. ("!;W!..;;J CommissifJlT No. CC 591458 > .
Signature of person taking acknowledgement (._ /00 . Y ~~ 1> ()m\)~M~. '&~ft.:%~~¡J~ß,g¡ '~. 009 > : ment-typed, printed or starr
ß lie an -',- -»'800StJI1i:at4Jp,rubçr'1~t;,i!<TtY;""'n'-"Æ-"rynÆ,gco, '. ztft:? /;;
APPLICATION APPROVEr:4!y ~.. ~ (((((~ F~f%'ifbm6'ètW(D'áfi:((('({(((((~' L l' /,/b¿
ISSUANCE OF TIllS REVISE E T DOES NOT A(;TIIOKÎZE VIOLATITY CODES OR DEE RESTRICTIf0
FEES FOR REVISIONS ARE NOT REFUNDABLE
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
INFORMATION CHECKLIST
Dear Applicant - in order to expedite your permit request, kindly review the following
items of information, which are necessary to process your request.
Please note the checked items below that may be applicable.W e wilA,Q pTe~e2 t3 4
review the information concerning your project at your earliest convenience.
o Site Plan Approval
o DOT Approval
o South Florida Water Management Approval
o Lake Worth Drainage
o Department of Business Regulation
o Development Order
o Corporate Resolution or notarized letter designating authorized agent
~ Notice of Commencement (OVER $2500.00)
o Water and sewet locations
rr Project drawings drawn to scale that are sufficient to describe the proposed scope of work.
.
o Certified survey'of property and site.
o Soil Test (if applicable)
o Utility easements (if applicable) I
.--k' 0 £J 0 c::- Win ,.ç¡ 0 vJ
P Product approval "I D 90 (L C~ ~ I .0.2)
~ Site plan showing all building improvements, dimensions and proposed setbacks.
IT / Foundation Plan (if applicable).
Œ( / Floor Plan(s).
~ / Building elevations - all sides.
ø / Typical wan section.
g" Electrical riser diagram (if additional service is contemplated).
o Plumbing riser diagram (tied into existing service, if applicable). '[)\ ~ .. (\;. ~ ~ W ~ J\
o A/C Plans (if applicable). ~~ p" II
J U r-¡AY I b 2000 ::J
o Energy calculations. .
I !
o Truss drawings or note that shop drawings will be provided (if applicable). BU!LD!f\JG DiVISiON
o Engineering seal on plan. f ~ ~~ fa ill) [p) WI ·
1f;( Cd>f')¿ S .0 r- 8u'-e<-...':::i---O+ '.J
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ADDITIONAL INFORMATION REQUIRED
~ IfOwner/Builder, a completed Owner/Builder affidavit.
~ ^ completed permit application with signatures and full contact information.
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