PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
Application number ..... : 01 00002638
Application status, date : FINALED
Property .......... : 409 NE tlTH AVE
PCN ............. : 08-43-45-21-22-005-0070
Lot Number ......... :
Zoning ........... : R2 DUPLEX (9.68)
Application type ...... : F FENCE
Application date ...... : 6/26/01
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 2629
6 FT WOOD W/1 GATE
RA
300
0
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DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
COMPLETE EACH BOXED ENTRY
Rec. #
Permit #
(FOR SUB PERMITS ONLY)
IOwner's NameI
~Owner's AddressI
Fee Simple ~itle Holder's Name
Fee Simple Title Holder's Address ! V [ v
Contractor's Compan~
Contact person and emergency phone
Company Address
City
.
ob AddressI
egal Description~ . _ ~ _
Bonding Company
DUPLEX MULTI-FAMILY
Bonding Co. Address
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
SINGLE FAMILY ~
check one)
(Palm Beach County Property Control fl)
JOwner's Phone ~
State Zip
lCompany Phone
Pager/Fax#
State Zip
(If other than owner's)
(If other than owner's)
OFFICE
Zoned
State
INDUSTRIAL
ESTIMATED VALUE OF'CONSTRU¢TIONI $
DETAILED DESCRIPTION OFWOR~: ~(~'r~ ~h~ ~~ -- ~ F4 ~ [ g~
CHECK REVIEWER REQUIRED:_. / - ' ~J -
I ELECt ~ ~ IS~C~ ' IF[R~ ~YHE~
Application is hereby required to obtain a pe~it to do work and installations as indicated. I cedi~ that no work or installation has
commenced prior to the issuance of a permit and that all work will be pedormed to meet the standards of all codes, laws, rules and
regulations governing construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL, PLUMBING,
SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS AND AIR CONDITIONING WORK, ETC.
OWNER'S AFFIDAVIT: I cedi~ that all the foregoing information is accurate and that all work will be done in compliance with all applicable
codes, laws, rules and regulations governing construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Prope.y Owner's or Agent's Signature ~ ~
Date
STATE OF FLORIDA, CO~TY OF PALM BEACH
take a] ~.wh° i~~g.~ g[~as ~x ~~d~~Pr°~uced~~- ~ - ~-- ~ as identification and who didO(did not)
Signa - -_ .... ent Name of officer taking ac~owledgement - t~ed,
printeffor stamped e or ra~ Serial Number, if any ~
Contractor's Signature Date
STATE OF FLOR/DA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this
who is personally known to me or who has produced
take an oath.
(date) by
as identification and who did (did not)
(SEAL)
Signature of person taking acknowledgement
printed or stamped
Title or rank
Name of officer
taking acknowledgement - typed,
Serial Number, if any
(Certificate of Competency Holder)
Contractor's State Certification of Registration No.
Liability Insurance Expiration D~t~
Workers' Compensation Expi~J,i~_n DateR i /~ /0
Application Approved By ~,/~~' Permit Officer Date: ~, ~'
I~- ~ -I
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 granting 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 commenced. All 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 AUTHORIZE VIOLATION OF DEED RESTRICTIONS
FEES ARE NOT REFUNDABLE
S:\DEVELOPMENT~FORMS.DOC\PERMiT APPLICATION MOD.A. DOC- Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000
APPLICATION #
APPLICATION DATE:
SETBACKS:
ZONE:
(THIS SIDE FOR OFFICE USE ONLY)
LEFT
RIGHT
MASTER PERMIT#
APPLICATION ACCEPTED BY:
FRONT REAR
TYPE OF CONSTRUCTION
OCCUPANCY TYPE
FENCE TYPE
ROOF TYPE
FLOOD ZONE
BASE FLOOD ELEVATION
FINISH FLOOR ELEV. (PROPOSED)
NUMBER OF UNITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
AREA SQUARE FEET (GROSS)
AREA SQUARE FEET (A/C)
# OF STORIES
# OF BEDROOMS
ADDITIONAL FEE
BCAIF
PARKS FEE
PENALTY FEE
PUBLIC BLDG. FEE
RADON FEE
ROAD IMPACT FEE
SCHOOL FEE
SEWER FEE
WATER FEE
FIRE DEPT. FEE
OVERTIME FEE
SUB-TOTAL
REMARKS:
Recpt #
VALUATION
SINGLE FEE
Building
Clearing & Grubbing
D, rainage
Electrical
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving ' -
Paving/Drainage ~
Plumbing "~'\
Roofing
Sign
Site Lighting
SUB TOTAL
TOTAL
LESS PLAN FILING FEE
CK #
Cash Rec'd from:
FEE
Accepted by: (Initials)
IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS
SUBJECT TO A FINAL INSPECTION ONLY.
AUTHORIZED for CERTIFICATE OF OCCUPANCY:
Date
AUTHORIZED for CERTIFICATE OF COMPLETION:
Date
BALANCE DUE
Recpt # CK #
Cash Rec'd from:
Accepted by: (Initials)
S:\DEVELOPMENT~.FORMS.DOC\PERMiT APPLICATION MOD.A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000