PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
2/12/02
13: 35: 03
Application number ..... : 00 00004155
Application status, date : CERTIFICATE ISSUED
Property .......... : 2320 S FEDERAL HWY
PCN ............. : 08-43-45-33-00-000-1440
Lot Number ......... : 144
2/11/02
Zoning ........... : R3 MULTI FAMILY (10.80)
Application type ...... : MA MULTI-UNIT APARTMENT
Application date ...... : 9/07/00
Tenant nbr, name ...... : TYPE 1 44 UNITS
Master plan nbr, revwd by : WE
Estimated valuation .... : 2163450
Total square footage .... : 0
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 9871
Press Enter to continue.
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DEPARTMENT OF DEVELOPMENT ,..,. · ..
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
Permit #
(FOR SUB PERMITS ONLY)
PCN#
Owner's Name All-m~n l}evel_nmenl~ Cn['~.
Owner's Address ~nl C.n~?n~nr~ Rlv&.
City Boca Eaton
Fee Simple Title Holder's Name
Fee Simple Title Holder's
Contractor's Company
Contact person and emergency phone # Jose Samae11
Company Address 7695 SW [04th Street
,(Palm Beach County Property Control #)
Owner's Phone# 561-997-8661
State ['"' Zip 33&31
(If other than owner's)
(if other than owner's)
Company Phone #
- 305-273-9911
~ Page~Fax~ 305-273-9424
City
Miami
'~ ' Zip. 33156
Job Name Tuscany on
JobAddress 2320 South Federal Ib~. ~ (~
Legal Description see attached '~ ':'~'"
//
_ ¥ zo.
Bonding Company ~ / ~ ~ ~Y
Bonding Co. Address r/ ~ ~& Ci~ ~~' c ~: ~ ~ Stets
Archit~Engin~r's Address 7695 SW I04th~~
Modgage Lend~s Name ~/ _
Modgage Lender's Address., ; ~
S~GLE FAMILY DUPLEX ~-FA~]LY ~ HOI~L ~TAIL O~[CE
(ch~k one)
ESTIMATED VALUE OF CONSTRUC~ON $ ~/ }&~/A~o
D~AILED DESCRIPTION' O~ WORK: Multi-family residential building.
· ype ~ on site pl'~ Total of 4~ un/ts.
INDUSTRIAL
Described as Buildin~
Application is hereby required to obtain a permit to do work and Installations as indicated. I certify that no work or installation has
commenced pdor to the issuance of a permit and that all work will be performed 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, TANK~ AND AIR ~;ONDITIONING WORK, ETC.
OWNER'S AFFIDAVIT: I certify 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 B OUR NOTICE OF COMMENCEMENT.
Property Owner's or Agent's Signature E~E~Y Date ~/, 4./
STATE OF FLORIDA, COUNTY OF PALM BEACH
who is ~n~ty kno~ to me or ~o h~ ~ as id~fification ~d who did (did
take an oa~. .~,~% A~ ~
Si~a=eof..o.~.gac~owledBem~t ~ ~~ N~ of o~c. ~ ~c~owledg~en,- ~ed,
printed m s~ed ~ . ~ ~Tit~ or ~ ~ .~al N~r, if ~y
Cont.cto,. ,ignature ~~~~~ Date ~GX o~
STA~ OF FLORA, OF P~(~CH
who. i~ ~~o~. ~~~ue~d ~ ( ' ~ id~fica~on and who. did (did
take ~. *~*~ C~m~si~ ~ , -. /
'S~L) .,~, -~~07~ ) ~ ,/ /
primed or s~ ' . ' . 'Tide or m~ Serial N~r, if any.
(Certificate of Competency Hold. er)
Contractor's State C~rtiflcation of Registration No.
Liability Insurance Expiration Da~te~ ~
Working' Compensation Ex,~~ ./'"Z" _
Application Approved By ~~_..,~,~~'/-.~--~"~,~"~..~ Permit Officer Date:
'- -
Any change in building p peciflcatio st 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 pdor to obtaining permit,
ISSUANCE OF THIS PERMIT DOES NOT AUTHORIZE VIOLATION OF DEED RESTRICTIONS
FEES ARE NOT REFUNOABLE
APPLI~CATION #
APPLICAT;0N DAT~:
SETBACKS:
ZONE:
(THIS SIDE FOR OFFICE USE ONLY)
LEFT
RIGHT
MASTER PLAN #
RECEIVED BY:
FRONT
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 (NET)
# 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
SUB-TOTAL
SINGLE FEE
Building
Cleadng & Grubbing
Drainage
Electrical
Excavalion
Fill
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drair~age
Plumbing
Roofing
Sign
Site Lighting
REAR
SUB-TOTAL
REQUIREMENTS for
CERTIFICATE OF OCCUPANCY
CERTIFICATE OF COMPLETION
FINALS:
SITE SIGN
FIRE ~ FENCE/BUFFER WALL
DRAINAGE
PAVING ~ OTHER
SITE LIGHTING OTHER
AUTHORIZATION for CERTIFICATE OF COMPLETION:
Date
TOTAL
LESS PLAN FILING FEE
TOTAL AMOUNT DUE
RECEIPT NUMBER
DATE ISSUED
# of Units
Commercial:
INTERIM SERVICES FEE CALCULATIONS:
Residential:
X =
Applicable Interim
Monthly Fee Services Fee
Divided by 1,000 =
# ot~ Sq. Ft (rounded to Base Sq, Ft
Nearest tenth) Rate
Base Sq. Ft Ap~,.,,able
Interim
LEGEND: GREEN SCREEN ENTER INPUT
RED SCREEN--"DO NOT ENTER ANY DATA"
YELLOW SCREEN REFERENCE DATA ONLY
APPLICATION DATE
FLOOR LEVEL
PERMIT NUMBER-
Setbacks:
Left: 30
Right: ~
Front: 210
Rear: 65
Type Of Const: vls
Occupancy Type: R
Roof Type: 5
Finish Floor Elev: 8
Parking provided: 30
Parking req'd: 24
Gross Area S.F.: _6_9_7_2Q
Air cond. Area:# A2 805
Gar/Corr. 1 st.fl.s.f. 9787
Covered porch-entr~ 1859
Number of Bed rms: _1_
Number of Units: 8
Total Sq.ft. 18086
Air cond. Area:# B1 1015
Corr.2nd fl. S.Ft: 907
Covered porch-entr~ 1291
Number of Bed rms: 1
Number of Units: 8
Total Sq.ft. 10318
Air cond. Area:# C2 1250
Corr.3rd.fl. S.Ft: 907
Covered porch-entr~ 1291
Number of Bed rms: 2
Number of Units: 16
Total Sq.ft. 22198
Air cond. Area:# D1 1410
Corr.4th fl S.Ft: 907
Covered porch-entr~ 1291
Number of Bed rms: 3
Number of Units: 12
Total Sq.ft. 19118
Application Est. $2,163,450
Standpipe-Sprkl N
Fire Pumps N
Fire Det N
Fire Supp. N
Plan Review Sq.FT. Y
Other Fees O.T.
09/05/2000 EFFECTIVE DATE 1/1/00
4
"RESIDENTIAL WORK SHEET FOR PERMIT FEE CALCULATION"
00-4155 TYPE OF PERMIT B MASTEF
EXAMPLE: B=BLDG,E=ELEC,ME=MECH,PL=PLMBG,
S--SIGN,R=ROOF,L--LANDS,P=PAVlNG
D-'DRNGD,SE=SEWER,EX=EXCAV.
359,545
273,253
25,952
$658,75O
COST: OTHER FEES:
Bcaif
Parks Fee
Pub.Bldg Fee
Radon Fee
Road Impact Descrp. "A"
School Fee
Sewer Fee-#Bed Rm. 84
Water Fee
Fire Dept. fee
SUB-TOTAL
SINGLE FEE VALUATION
453,340__
25,323
18,022
$496,685__
Site
Bldg.
Elec.
Mech
Plmbg.
$0.00
$3,303,369
$0.00
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$1,116,600~
$25,323__
$18,022__
$0~
$1,159,945__
$944,644
$25,323
$18,022
$987,989
0
Roof
Drngd
Excav.
Lands
Paving
.Sign
Sewer
SUB-TOTAL
TOTAL FEE
LESS PFF
$3,303,369
$o.oo
$o.oo
$o.oo
$o.oo
$4,043.76
$850.00
TOTAL AMT DUE
$850.00
$348.60
$15,957.92
$4,551.56
$348.60
$94,100.16
$29,624.80
$8,499.20
$47,769.60
$4,043.76
$206,094.20
FEE
$0.00
$52,853.90
$0.00
$0.00
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$52,853.90
$258,948.10
$10,384.56
$248,563.54
LEGEND: GREEN SCREEN ENTER INPUT
RED SCREEN--"DO NOT ENTER ANY DATA"
YELLOW SCREEN REFERENCE DATA ONLY
APPLICATION DATE
FLOOR LEVEL
PERMIT NUMBER-
Setbacks:
Left: 30
Right: 42
Front: 210
Rear: 65
Type Of Const: vls
Occupancy Type: R
Roof Type: 5
Finish Floor Elev: 8
Parking provided: 30
Parking req'd: 24
Gross Area S.F.: 69720
Air cond. Area:# A2 805
Gar/Corr. 1 st.fi.s.f. 9787
Covered porch-entry 1859
Number of Bed rms: _!_
Number of Units: 8
Total Sq.ft. 18086
Air cond. Area:# B1 1015
Corr.2nd fl. S.Ft: 907
Covered porch-entry 1291
Number of Bed rms: 1
Number of Units: 8
Total Sq.ft. 10318
Air cond. Area:# C2 1250
Corr. 3rd.fl. S.Ft: 907
Covered porch-entry 1291
Number of Bed rms: 2
Number of Units: 16
Total Sq.ft. 22198
Air cond. Area:# D1 1410
Corr.4th fl S.Ft: 907
Covered porch-entry 1291
Number of Bed rms: 3
Number of Units: 12
Total Sq.ft. 19118
Application Est. $2,163,450
Standpipe-Sprkl N
Fire Pumps N
Fire Det N
Fire Supp. N
Plan Review Sq. FT. Y
Other Fees O.T.
09/05/2000 EFFECTIVE DATE 1/1/00
4
"RESIDENTIAL WORK SHEET FOR PERMIT FEE CALCULATION"
00-4155 TYPE OF PERMIT B MASTE
EXAMPLE: B=BLDG,E=ELEC,ME=MECH,PL=PLMBG,
S=SIGN,R--ROOF,L=LAN DS,P=PAVlN G
D=DRNGD,SE=SEWER,EX=EXCAV.
359,545
273,253
25,952
$658,75O
453,340
25,323
18,022
$496,685
$1,116,600
$25,323
$18,022
$0~
$1,159,945
$944,644
$25,323
$18,022
$987,989
0
$3,303,369
$0.00
$0.00
$0.00
$0.00
$4,043.76
$530.00
COST: OTHER FEES:
Bcaif
Parks Fee
Pub. Bldg Fee
Radon Fee
Road Impact Descrp. "A"
School Fee
Sewer Fee-#Bed Rm. 84
Water Fee
Fire Dept. I fee
SUB-TOTAL
SINGLE FEE VALUATION
Site
Bldg.
Elec.
Mech
Plmbg.
$0.00
$3,303,369
$0.00
$0.00
$0.00
$0.00
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
Roof
Drngd
Excav.
Lands
Paving
Sign
Sewer
SUB-TOTAL
TOTALFEE
LESS PFF
TOTAL AMT DUE
$530.00
$348.6O
$15,957.92
$4,551.56
$348.60
$94,100.16
$29,624.80
$8,499.20
$47,769.60
$4,043.76
$2O5,774.20
FEE
$0.00
$52,853.90
$0.00
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$52,853.90
$258,628.10
$10,384.56~
LEGEND:GREEN SCREEN ENTERINPUT
RED SCREEN--"DO NOT ENTER ANY DATA"
YELLOW SCREEN REFERENCE DATA ONLY
APPLICATION DATE
FLOOR LEVEL
PERMIT NUMBER-
Setbacks:
Left: 30
Right: 42
Front: 210
Rear: 65
Type Of Const: v 1 s
Occupancy Type: B
Roof Type: 5
Finish Floor Elev: 8
Parking provided: 30
Parking req'd: 24
Gross Area S.F.: ~
Air cond. Area:# A2 805
Gar/Corr. 1 st.fi.s.f. 9787
Covered porch-entr~ 1859
Number of Bed rms: 1
Number of Units: 8
Total Sq.ft. 18086
Air cond. Area:# B1 1015
Corr.2nd fl. S.Ft: 907
Covered porch-entr~ 1291
Number of Bed rms: 1
Number of Units: 8
Total Sq.ft. 10318
Air cond. Area:# C2 1250
Corr.3rd.fl. S.Ft: 907
Covered porch-entr~ 1291
Number of Bed rms: 2
Number of Units: 16
Total Sq.ft. 22198
Air cond. Area:# DI 1410
Corr.4th fl S.Ft: 907
Covered porch-entr~ 1291
Number of Bed rms: 3
Number of Units: 12
Total Sq.ft. 19118
Application Est. $2,163,450
Standpipe-Sprkl N
Fire Pumps N
Fire Det N
Fire Supp. N
Plan Review Sq. FT. Y
Other Fees O.T.
09/05/2000 EFFECTIVE DATE 1/1/00
4
"RESIDENTIAL WORK SHEET FOR PERMIT FEE CALCULATION"
00-4155 TYPE OF PERMIT B MASTEF
EXAMPLE: B=BLDG,E=ELEC,ME=MECH,PL=PLMBG,
S=SIGN,R=ROOF,L=LAN DS,P=PAVING
D=DRNGD,SE=SEWER,EX=EXCAV.
359,545
273,253
25,952
$658,75O
COST: OTHER FEES:
Bcaif
Parks Fee
Pub. Bldg Fee
Radon Fee
Road Impact Descrp. "A"
School Fee
Sewer Fee-#Bed Rm. 84
Water Fee
Fire Dept. fee
SUB-TOTAL
SINGLE FEE VALUATION
453,340__
25,323__
18,022
$496,685__
Site
Bldg.
Elec.
Mech
Plmbg.
$0.00
$3,303,369
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$o.oo
$1,116,600__
$25,323__
$18,022__
$o
$1,159,945__
$944,644
$25,323
$18,022
$987,989
0
Roof
Drngd
Excav.
Lands
Paving
.Sign
Sewer
SUBTOTAL
TOTALFEE
LESS PFF
$3,303,369
$o.oo
$o.oo
$o.oo
$o.oo
$4,043.76
$810.00
TOTAL AMT DUE
0
$810.00
$348.60
$15,957.92
$4,551.56
$348.60
$94,100.16
$29,624.80
$8,499.20
$47,769.60
$4,043.76
$206,O54.20
FEE
$0.00
$52,853.90
$0.00
$o.oo
$o.oo
$o.oo
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$52,853.90
$258,908.10
$10,384.56
.$248~52-3.54
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
COMPLETE EACH BOXED ENTRY
Rec. #
Permit
(FOR SUB PERMITS ONLY)
PCN# f' (Palm Beach County P. roperty Control #)
IOwner'sName~ ~.."1-1~,..% ~e~dc./.-o,,o~,.~? C~,"iO iOwner,sPhonef~ (.~,j) c[c~_
~Owner's Address~ ~2-"L¢~ ~ ~_~ ,nc~. ~ ~ ~ · CU~ - --
~City [ ~ o~ ~~ State ~ Zip ~
Fee Simple Title Holder's Name (If other~han owner's)
Fee Simple Title Holder's Address , (If other than owner's)
Contractor'sCompan~ ~R ~L~ ~, ~ ~c~lCompanyPhone~ ~¢HI 5~-
IContact person and emergencY phone ~ ~(%~ ~~
Company Address I o % ~ ~ ~
~ r, ~,.-T Pager/Fax#
City ~' ~ ~ ~ ~' t State ~' C-. Zip ~ ~{
~ob Addres~ ~ ~ .. ~-~ ~ ,
JLegal Descriptionl
Bonding Company
Bonding Co. Address
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
SINGLE FAMILY DUPLEX
Zoned
City /,Y/~ State
__ MULTI-FAMILY __ HOTEL RETAIL OFFICE INDUSTRIAL
(check one)
ESTIMATED VALUE OF CONSTRUCTION
DETAILED DESCRIPTION OF WORK:]
CHECK REVIEWER REQUIRED:
~ ~ ~ ~STRUCT1 FIREI ~OTHER~
Application is hereby required to obtain a permit to do work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all codes, laws, rules and
regulations governing construction in this jurisdiction. 1 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 certify 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.
Property Owner's or Agent's Signature
Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instTument 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 Name of
printed or stamped .... t Title or rank
Contractor's Signature ,~ ~ -
STATE OF FLORIDA, COUNTY OF ?ALM
foregoing instrument was acknowledged before me this
The
who is personally known to me or who has'
take an oath. pr°dl ~
(SEAL)
Signature of person taking acknowledgement ~-- ' __l~ame of
printed or stamped
(date) by
Contractor's State Certification of Registration No.
Liability Insurance Expiration Date
Workers' Compensation Expiration Date
Application Approved By
(Certificate of Competency Holder)
officer taking acknowledgement - typed,
Serial Number,/f an~
Date C.~
as identification and who did (did not)
officer taking acknowledgement - typed,
Serial Number, if any
Permit Officer Date:
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
J:\SHRDATA\DEVELOPMENT1FORMS.DOC\PERMIT APPLICATION 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
Drainage
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)
J:\SHRDATA\DEVELOPMEN'RFORMS.DOC\PERMiT APPLICATION A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
COMPLETE EACH BOXED ENTRY
Rec. #
Permit #
(FOR SUB PERMITS ONLY)
PCN# ~_~,~'" _~-/~ ~f.9'-" _T',~' ~ 0~/~
~Owner's Name~ ~~ ~~Co~ ~7~
Owner s Address] ~/ ~~ ~g~ ~.~,.~ ~o
City ~~ ~~ State
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address
Contractor's Compan~ ~, ~, ~ ~, ~&~ ~c
Contact person and emergency phone ~
(Palm Beach County Property Control #)
IOwner's Phone ¢~ ,.~./'-9"~/7 ~'~'~'}
(If other than owner's)
(If other than owner's)
]~-m-pany Phone ~ _~"~/-g~ -$'71 ~J
Company Address /.~o¢ ,,,"~, ?-~,,~,ao- /~-/',,*'~,¢,~ ,,~O ~ ~ Pager~~¢/-~o-~
City ~~ ~m ~ ~. State /~ Zip
pcb Nam~ ~~~
~obAddress] ~~ ~ ~~ ~~
~LegalOescriptionI ~-~ ~~~~ ~ ~.~ ~.~ ~/~
~ ~ ~ ~ , Zoned
Bond~g ~om~ny
Bonding Co. Address
Architect/Engineer's Name
City State
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
SINGLE FAMILY __ DUPLEX MULTI-FAMILY HOTEL RETAIL OFFICE INDUSTRIAL
(check one) O ~ --
ESTIMATED VALUE OF CONSTRUCTIONI $ ~" 90 "~
IDETAILED DESCRIPTION OF WORK:I /'.,,t~J"~-./rz.~,~-7-,,~.,~' ~ ~-¢7'M ~:;;:~/-~'2-J'" mC,~-z,~
REVlEWER REQUIRED: -
~ ~ ~STRUC~ ~FIREJ
ion is hereby required to obtain a permit to do work and installations as indica~d. 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 cedify 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 ~ICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU~TICE OF COMMENCEMENT.
Property Owner's or Agent's Signature .~/~/~ :' ~""~ Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
Thc foregoing instrument ,vas acknowledgcd bcfore me this ~~ ~,~ (date)by ~~
who is personally knmvn to mc or who has produced ~ I- as identification and who did (did not)
take an oath. ~ ,,~'~',,, ~.4
~."~"-~C~ ~ . ·
(SEAL) fl =~:~4z E"-'~ .... ,"
~ . - ' ~ ~ .... ~, ~:c~ 56~ .~ taking acknowledgement typed,
S]anatme of person lakm~ acknowlcd,,ement ~,;~or~ ~ d t -
printed or stare ed ' . . - .......... '"'. - .
P ~ ~/ ~ - Title m zank Serial Numb,,'
STATE OF FLORIDA, CO,T5 ~LM BEACH
The foregoing instrument was acknowledged before mc this (date) by
~vho is personally knoxvn to me or who has produced as identification and who did (did not)
take an oath.
(SEAL)
Signature of person taking acknowledgement
printed or stamped
Name of officer taking acka~owledgement - typed,
Tide or rank Serial Number, if any
Contractor's State Cedification of Registration No.
Liability Insurance Expiration Date
Workers' Compensation Expiration Date
Application Approved By.
(Certificate of Competency Holder)
Permit Officer Date:
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 starling. 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
J:\SIIRDATA~DEVEI .)PMENT~FORMS DOC PER,._ r APPI_ICAT!n"I MhD/'.,.DOC-~ Revis~,d 61t.°ff.)7. 1 !/4/o7,. l°~q,q , 'q9 g/qq 51P,0 a/no ql?~/?nnn
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
VALUATION FEE
REMARKS: '7' SINGLE FEE
Building
Clearing & Grubbing
Drainage
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
Recpt # CK #
Cash Rec'd from:
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)
J:\SHRDATA\DEVELOPfvlENT\FORMS.DOC\PERMIT APPLICATION MOD.A. DOC- Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5100, 8/00, 9/25~2000
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
COMPLETE EACH BOXED ENTRY
Rec. #
Permit # C~-Cx~'~C~'"~L~ t ~
(FOR SUB PERMITS ONLY)
PCN#
Owner's Name~
Owner's Address~
City ~~
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address
ontractor'sCompan~ ~o~ ~ ~o~<~ ~.
ontact person and emergency'phone ~ ~ ~-~OtO
Company Addres~
City ~ ~~[<
~ob Addres~
lLegal DescriptionJ
(Palm Beach County Property Control #)
W_.~y,.. [Owner's Phone ~(r-"~g3~- ~,~,
State t~ \,owiol~c~ Zip
(If other than owner's)
(If other than owner's)
ICompany Phone ~ _(~,'-~J~q-
Pager/Fax# ~¢"J~")~¢7 -
Zip
Zoned
Bonding Company
Bonding Co. Address
City State
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
SINGLE FAMILY __ DUPLEX __ MULTI-FAMILY ,~'"' HOTEL RETAIL OFFICE INDUSTRIAL
check one) --
ESTIMATED VALUE OF CONSTRUCTIONI $ ~ ~, ~
DETA,LED DESCR, PT,O. OF WOR :l C {
CHECK REVIEWER REQUIRED: ....
~ ~ ~ ISTRUC~ IF~REI pTHE~
Application is hereby required to obtain a permit to do work and installations as indicated. I cedi~ that no work or installation has
commenced prior to the issuance of a permit and ~at 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 ~ICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN A~ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. .
Prope~y Owner's or Agent's Signature ~ ~~ Date
STATE OF FLO~DA, CO~TY OF PALM BEACH / / ~ ~ '
The foregoing instrument was acknowled~edbeforeme this /' J ~-0/ (date) by ~o,-~ e /
who is ~ers~i~o~ ~d~ced '1[ .... as identification and w~did (did not)
take an 0~~25 ~V c~ss~hu ~ cc ~8~s~ Il / ~- ~~ ~ --
printed or stamped ~'~ ~'-.~,~( F~T~I~ or ra~ / ]~.Z Serial Numar, itany
Contractor's Signature ~ ~ ~'.. .; ~3~ ..~ / Date ~h~,"
STATE OF FLO~DA, CO~TY OF PALMBEACH ~ )
The foregoing instrument was acknowledged b~efore me this
who i~to me or who has produced
take an oath.
(date) by
as identification and who did (dfd not)
(SEAL) ~ "~.'~~ t ~ ,.~m ;r~ ~
Signature' of~~ ~~ ~ll~'/~/-F : ~-*'~d~*~' ~ O~
7~~~-~~' t~' , ~ N~me of officer taking ac~owledgement - ~ed,
printed or st~~f~~'~~ t~,~' ~-~ .... Title ~ra~' ~/o/d~ ~ Serial Number, if any
, ~. r~'' ~~-~ (Cedificate of Competency Holder) /
Contractor s Stat~'~ifi~6~~~--~ ~O ~ Ot~
Liabili~ Insurance Expiration Date 0~- t~- O~
Workers' Compensation Expiration Date ['~- ~-c~
Application Approved By Permit Officer Date:
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
J:\SHRDATA\DEVELOPMEN~FORMS.DOC\PERMIT APPLICATION A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000
(THIS SIDE FOR OFFICE USE ONLY)
APPLICATION #
APPLICATION DATE:
LEFT
SETBACKS:
ZONE:
RIGHT
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
MASTER PERMIT #
APPLICATION ACCEPTED BY:
FRONT REAR
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:
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
Recpt #
VALUATION
SINGLE FEE
Building
Clearing & Grubbing
Drainage
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:
Accepted by: (Initials)
.FEE
BALANCE DUE
Recpt # CK #
Cash Rec'd from:
Accepted by: (Initials)
J:\SHRDATA\DEVELOPMENT~FORMS.DOC\PERMiT APPLICATION A.DOC - Revised 6118/97, 11/4/97, 12/98, 6~99, 8~99, 5~00, 8~00, 9/2512000
PCN#
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
(Palm Beach County Property Control #)
Permit# 00000041 55
(FOR SUB PERMITS ONLY)
Owner's Name AT,TMAN T3RV~..T.OPMRN'P CORP. Owner's Phone #
Owner's Address 2201 CORPORATE BLVD.
City BOCA RATON State FLORIDA
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address
Contractor's Name ANDREU & ASSOC,, INC, Contractor's Phone
Project Manager and emergency phone~ ARTURO SILVEIRA. 954/943-703~
Contractor's Address .2~5_.S~ !4~h..~VENUE~ , , Beepe~/Fax~ qg4/7R~-qR66
City p~MPA~O R~ACH State F~OR~DA
Job Name THS~ANY
Zip 33431
(If other than owner's)
(If other than owner's)
954/943-7032
Zip 33069
Job Address ,q _ PRDW. RAT, RTCJ4WA¥: ROYNTON BEACH: FL.
Legal Description RT,D, # ],
Bonding Company
Bonding Co. Address
Architect/Engineer's Name
City
State
Architect/engineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
SINGLE FAMILY DUPLEX __ MULTI-FAMILY X HOTEL ~ RETAIL
(check one)
ESTIMATED VALUE OF CONSTRUCTION $ 1 55,400.00
DESCRIPTION OF WORK: ELECTRICAL WIRING FOR NEW BUILDING.
OFFICE INDUSTRIAL
Application is hereby required to obtain a permit to do work and installations as indicated. I.certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed 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 certify 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 '10 OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Property Owner's or Agent's Signature Date
STATE OF FLORIDA, 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 acknowledgcmcat .4
priated or stamped
Contractor's Signature
STATE OF FLORIDA, COUNTY EACH
Thc foregoing instrument was ackne~Iedged before me this/5'~,,'~
who is persomdly known to mc or who has produced
take an oath.
Signature of person taking acknowledgement
printed or stamped Title
Name of officer takiog acknowledgcngnt - typed,
Serial Number, ff any
Date -3 / ~ (/or
Name
Serial
(date) by
as idcmification and who did (did not)
(Certificate of CompetencyHolder)
Contractor's State Certification of Registration No. P,C # .0001 257 .
Liability Insurance Expiration Date ' 0 ~ / ~ 1 / O 1
Workers' Compensation Expiration Date 0:2 / 0 7 / 0 2.,
Application Approved By Permit Officer Date:
of officer taking acknowledgement - typed,
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 consid, eration 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
',\CI[\IvtAIN\,gHRI')ATA\DEVEI.C)PMENT~FORMS.D¢')C\PI.',RIvI1T ..xPP1 I0 VFI(')N DOC
(THIS SIDE FOR OFFICE USE ONLY}
Application #
Master Plan #
SETBACKS:
ZONE:
APPLICATION DATE:
RECEIVED BY:
LEFT RIGHT FRONT REAR
TYPE OF CONSTRUCTION
OCCUPANCY TYPE
ROOF TYPE
FENCE TYPE
AREA SQUARE FEET
FLOOD ZONE
BASE FLOOD ELEVATION
FINISH FLOOR ELEVATION
NUMBER OF STORIES
NUMBER OF UNITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
# OF BEDROOMS
# OF BATHROOMS
ROAD IMPACT FEE
SEWER FEE
WATER FEE
PARKS FEE
SCHOOL FEE
PUBLIC BLDG. FEE
LAW ENFORCEMENT FEE
RADON FEE
BCAIF
ADDITIONAL FEE
PENALTY FEE
SUB-TOTAL
REMARKS:
SINGLE FEE
Site Improve.
Building
Electrical
Mechanical
Plumbing
: Roofin'g ..
.. Drainag~
' Exoavatlor~
Landscaping
Paving
Sign
Sewer
VALUATION
FEE
SUB-TOTAL
REQUIREMENTS for
CERTIFICATE OF OCCUPANCY
CERTIFICATE OF COMPLETION
FINALS:
'SITE ~ SIGN
FIRE ~ FENCEJBUFFER WALL
DRAINAGE
PAVING ~ OTHER
SITE LIGHTING OTHER '
AUTHORIZATIONforCERTIFICATEOFOCCUPANCY:
Date
AUTHORIZATION for CERTIFICATE Of cOMPL.'E~TION:
TOTAL
LESS PLAN FILING FEE
TOTAL AMOUNT DUE
RECEIPT NUMBER
DATE ISSUED
Date
INTERIM SERVICES FEE CALCULATIONS:
Residential:
X =
# of Units Applicable
Monthly Fee
Com~nerciah
# of Sq. Ft
Base Sq. Ft
Revised 6/18/97, 11/4/97
Divided by 1,000
(rounded to
Nearest tenth)
Applicable
Monthly Fee
Intedm
Services Fee
Base Sq. Ft
Rate
Interim
Services Fee
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION
(Please Print)
COMPLETE EACH BOXED ENTRY
Rec. #
Permit #
(FOR SUB PERMITS ONLY)
PCN# (Palm Beach County Property Control #)
Owner's Name I-"/~-4 ~'~f-~,'-'~, ~'~IF~, ('~ Q,
IOwner's Phone
Owner's Address/~3~ (il)v~, [~id('~ ,
City ] ~-~ (~~--~ ~ ' State ~'[, Zip
Fee Simple Title Holder's Name (If other than owner's)
Fee Simple Title Holder's Address (If oth~r than owner's)
Contractor's Compan~ ~' [Y'} l~)[.t.L"~ ~ )~1~("~ Company Phone ~
~Contact person and emergency phone ~ ', ~ "
Compan~ddress~~ (~ ~00_ ~, '~t.[~. Pager/Fax~
City ~(;'f~--~'~" r-[~g - - State F~ ·
Zoned
Bonding Company
Bonding Co. Address
Architect/Engineer's Name
City State
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's Address
SINGLE FAMILY __ DUPLEX __ MULTI-FAMILY __ HOTEL RETAIL OFFICE INDUSTRIAL
check one) --
ESTIMATED VALUE OF CONSTRUCTION
DETAILED DESCRIPTION OF WORK:
CHECK REVIEWER REQUIRED:
~ ~ ~ ~'"~ [STRU Cl~ [FIRE~ ~)THER~
Application is hereby required to obtain a permit to do work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed 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 cedify 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.
Property Owner's or Agent's Signature
Date
STATE OF FLORIDA, COUNTY OF PALM BEACII
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
Contractor's Signature ',.---'"'"'% ~
STATE OF FLORIDA, COUNTY OF PALM BEACH
Name of officer
taking acknowledgement - typed,
Serial Number, if any __
The foregoing instrun, ent was ack,m,wl,e, dg,ed, ,before. me thiSwho is ~ "' ~-[q~ CDt (date) by
pe~d,~llli,~I,Ull~T~ul,m~ p~J~luce, as identification and who did (did not)
take an oa~ ~ I~ l: ~ ~ ~
Signanlre ~r~,
~~.~'(J~ame of officer taking acknowledgement - typed
printed or stamped O- '~'itlg~r rank ~ Serial Number, if any
(Certificate of Competency Holder)
Contractor's State Cedification of Registration No.
Liabili¢ Insurance Expiration Date
Workers' Compensation Expiration Date
Application Approved By Permit Officer Date:
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 starling. 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
J:\SHRDATA\DEVELOPMEN]AFORMS.DOC\PERMIT APPLICATION A, DOC- Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99. 5/00, 8/00, 9/25/200P
APPLICATION #
APPLICATION DA1 E:
SETBACKS:
ZONE:
('i HIS SIDE FOR OFFICE U3E ONLY)
MAS'I-E!¢ i;EI~MIT #
L E F 1-
APPLIC/, ~ ION ACCEPTEI } BY'
I RONT RE/,.!~
TYPE OF CONSTRUCTION
OCCUPANCY 1 YPE
FENCE TYPE
ROOF '1 YPE
FLOOD ZONE
BASE FLOOD ELEVA] ION
FINISH FLOOR ELEV. (PROPOSED)
NUMBER OF UNITS
PARKING SPACES REQUIRED
PARKING SPACES PROVIDED
AREA SQUARE [:EEl (GROSS)
AREA SQUARE FEE f (A/C)
# OF STORIES
# OF BEDROOMS
ADDI I !ONAL FEE
BCAII:
PAR K,~-; I:EE
PENAL i Y FEE
PUBLIC BLDG. FL!
RADO[.I FEE
ROAD IMPACT
SCHOr~L FEE
SEWEf ', FEE
WA'fF~; FEE
FIRE [)t:f' r. FEI-:
OVEI'~, liME FEE
SUB:I ~ ~ FAL
REMARKS:
IF THIS BOX IS NO'! COMPLETED, 'ltlIS PERMIT IS
SUBJEC1 TO A FINAL INSPECTION ONLY.
AUTHORIZED for CEI~,'I IFICATE OF OCCUPANCY:
Date
AUTHORIZED for CERIIFICATE OF COMPLFTION:
Date
SINC. I_E FEE
BuiMi~
Clearly11 & Grubbi~
Drai~,~tle
Elech
F-_xcrl~,'; dior
Fill
[:ire
Fire :71'~inkler
Irrig;d;, u~
Lan,Jn~:aping
Mecl~;~;~ical
Pavi~ ~?
Parting/Drainage
Plumbing
Roof irU
Sig~
Site I.~ Chting
VALUATION
FEE
t'OFAL
LESS i~L,A.N Fll..h ;G FEE
Recpl fl t !t
BAD': ~CE DUE
Recpt~ ~ ~ ~I
Cash Rec'd
Acceph:d by: (Inili;¢)
J:\SHRDATA\DEVELOPMEt, I!;rr-~IRMR.DOC\PER!,AiT Ar~!,l InATInl',l A F)f'hC ~' ' ' r~nal7 ~ 4/~,r~ .... n ...... n n.~.-,
BUILDING DIVISION
BUILDING PERMIT REVISION APPLICATION
PLEASE PRINT
ORIGINAL PERMIT
PROJECT NAME: "~$
Contractor's Name ~
MASTER PLAN #
ADDRESS:
(~,
TOTAL ESTIMATED VALUE OF THIS REVISION: $
~DESCRIPTION OF WOPd5 (Pleas~ecify in detail what is being revised from original ermit ·
Value of Work: $ .~
.DRAINAGE:
TRicALof Work: $
Value of Work: $ ~'"'
.F..XCAVATION:
Value_~k: $
FILL:
_,/~iRlUe of Work: $
E SPRINKLER_:
Value of Work: $
JRRIGATION:
Value of Work:
.LANDSCAPING:
Zl alue of Work: $
ECHANICAI,:
- 0 I
Value of Work: $
PAVING_: ._/aa
Value of Work:
pAVING/DRAINAGE:_
Value of Work: $ /
PLUMBING:
V,~lue of Work: $ ~
Value of Work: $'
SIGN:
Value of Work: $
SITE LIGHTING:
Value of Work: $..~_
wish to revise the above referenced permit to perform the work described herein. I certify that all xvork will be constructed in
:onformance with all laws, codes, regulations, rules, etc. governing Boynton Beach, and I certify that the above information is true
md correct.
£ontractor's Signature
;TATE OF FLORIDA, COUNTY OF PALM BEACH
'he Ibregoing instrument was acknowledged belbre me this
roduced
(date) by
(type of identification) as identil
&dS ..........................................................................
tgnature of person taking acknowledgement
Title or rank
Ser
Date:
,PPLICATION APPROVED BY permit offibe?' D[te: ---
qSUANCE OF THIS REVISED PERMIT DOES NOT AUTHORIZE VIOLATION OF CITY CODES OR DEED RESTRICTIONS
FEES FOR REVISIONS ARE NOT REFUNDABLE
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT REVISION APPLICATION
PLEASE PRINT
ORIGINAL PERMIT
PROJECT NAME:- [' ~/5
Contractor's Name ~
MASTER PLAN #
ADDRESS:
TOTAL ESTIMATED VALUE OF THIS REVISION: $[~=' ~OO! O'fi-Dx)
DESCRIPTION OF WORI~. (Pleas~..~ecify in detail wp~t is being revised from original pe~it);
BUILD~G'
Value of Work: $
CLEAR~G & GRUBB~G:
Contractor's Phone
Value of Work: $
DRAINAG___~E:
Value of Work: $
Value of Work: $ ~
EXCAVATION: __~/~.
Value of Work:
FILL: __~ ~k
Value of Work:
FIRE SPRINKLER:
Value of Work: $
IRRIGATION:
Value of Work: $ -~-
LANDSCAPING:
Value of Work: $
MECHANICAl.:
Value of Work: $
PAVING: ._~
Value of Work:
PAVING/DRAINAGE:
Value of Work: $ /
PLUMBING:
Value of Work.', $ ~ ,
ROOFING: ~~4 ga4~ ~
Value of Wgrk: $'
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 work will be constructed in
conformance with all laws, cod.es, regulations, roles, etc. governing Boynton Beach, and I certify that the above information is true
and correct. ~ - -~ '~~ t .
Con tractor's Si gnat uTe/~/~~~J~______._~_~_ __ Date:
Fhe foregoing instrument ,vas acknowledged bell,o, re me this F-.. ~! ~ (date) by /Iq ~4~/~L. ~ D'I [~.40~ , who is personally' kngwa tom_~or who has
)roduced '~ ,, ~v , · ~t
~e,?~/.~l~,o Cnml a C~:.~/ype of identification) as identification and whod~'~ take an oath.
/'~ · .~ ,'~ tt-~ ~,"-~'.c~".?~. MYCOMMISSION# CC922244 EXPIRES
22,
lignature of person taking ach~ledgement
Name of officer taking acknowledgement-t~ed, primed or ~tam~d
Title or rank Serial number, if any
x~PLICATION ~PROVED BY ~ ~/~~ ..~ me~it
57UANCE OF THIS RE'raSED PEmIT DOES NOT AU~OmZE mOLATION OF
FEES FOR RE~SIONS ARE NOT REFUND~~ ·
(Tills 511)E FOR
App!ic,ati.on .#
PCN #
(Palm Beach County Property Control #)
ZONE:
OFFICE USE ONLY)
Master Plan #
APPLICATION DATE:
RECEIVED BY:
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 SQUAILE FEET (GROSS)
AREA SQUARE FEET (NET)
NUMBER 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:
REVISION #, /
II
Permit # O0 ~'
Date accepted submittal
~ompl~ted by ~
Completed b~ D~to to ~oco~d~
Dato ~nt~ed into ~ermit
Dato e~lled for co~ents Initials
_Completed by,
Date to Records
Date entered into Permit Log La)it--J/(D)Initials
Date called for comments I ' / -' ' Initials
TOP SHEET ONLY
~Building.
... Clearing & Grubbing
__Drainage
~lectricai
~Excavation Fill
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
~Plumbing
_, Roofing
Sign
Sile Lighting
VALUE FEE
SUB-TOTAL
TOTAL
LESS PLAN FILING FEE
TOTAL AMOUNT DUE
RECEIPT NUMBER
DATE PERMIT IssUED
Permit# ~ Review F II
Date accepted submittal
C6'mpleted by-' gaie to P&Z
P & Z Eng. Utilities ERC
_
ohce~ P.W. Parks Forester
Completed by .... Dale to Records
Date entered into Permit Log .,, Initials
Date called for comments Initials
\Development\FORMS.doc\REViSiON
APPLICATIONR.dOC 12/98,Rev.6/99,8/25/2000 new label attached
to application.
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
ORIGINAL PERMIT #
PROJECT NAME: '~']--o,.~4. ~ ~ ,., ~ '~, ~ }~ ~ ._.~/- '~ '/'°T~'~-~/"4 iA_p, pRESS: ,;~-3 ~L ~
Contractor's Name ~---'~'D & /{/-.~5c.. _.kr~¢/,_Sq~,~[E Contractor's Phone #
TOTAL ESTIMATED VALUE OF THIS REVISION: $ ~
DESCRIPTION OF WORK (Please specify in detail what is being revised from original permit):
BUILDING PERMIT REVISION APPLICATION
~' ~'~ ~=~ PLEASE PRINT
O 0 ~ MASTER PLAN#
BUILDING:
Value of Work: $
CLEARING & GRUBBING:
Value of Work: $
DRAINAGE:
Value of Work: $
ELECTRICAL:
Value of Work: $
EXCAVATIO~N:
Value of Work: $
FILL:
Value of Work: $
FIRE SPRINKLER:
Value of Work: $
IRRIGATION:
Value of Work: $
LANDSCAPING:
BLilLDIi,:G DEPAR:i,:.ENT i
PAV~G:
Value of Work: $
PAVING/DRAINAGE:
Value of Work: $
PLUMBING:
Value of Work: $
Valtte ofWork: $
SIGN:
Value of Work: $
SITE LIGHTING:
Value of Work: $
i wish to revise the above
conformance with all laws
and correct.
Contractor's Signature
STATE OF FLORIDA, COUNTY OF
The foregoing instrument was
produced
(SEAL) 'X.':.. ~",
Signature
ISSUANCE OF THIS REVISED
\
· Boynton Beach, and I c~bt~tat the above information is true
: Date: ('~) !t, 0.~, Cgk
who take an oath.
Name of officer taking acknowledgement-typed, printed or stamped
Serial number, if any O~
: Officer Date:
VIOLATION OF CITY CODES OR DEED RESTRICTIONS
FEES FOR REVISIONS ARE NOT REFUNDABLE