PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
2/21/02
13:53:53
Application number ..... : 01 00002783
Application status, date : FINALED
Property .......... : 1066 SW 25TH PL
PCN ............. : 08-43-45-32-02-005-0240
Lot Number ......... :
7/26/01
Zoning ........... : R1AA SINGLE FAMILY (5.40)
Application type ...... : AC AIR CONDITIONING
Application date ...... : 7/06/01
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 7139
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DEPARTMENT
BUILDING DIVISION
OF DEVELOPMENT
BUILDING PERMIT APPLICATION
Rec. #
Permit #
(Please Print)
COMPLETE EACH BOXED ENTRY
(FOR SUB PERMITS ONLY)
PCN#
Owner's Name~
Owner's Address~ Jo~-
City ~ ~. ~.
Fee Simple Title Holder's Name
Fee Simple Title Holder's Address
Contractor's Compan~
Contact person and emergency phone
(Palm Beach County Property Control #)
IOwner's phOne ~ "7 ~rO -_~O L~
State
ICompany Phone
Zip
(If other than owner's)
(If other than owner's)
State /~,a~e, r/Fax#
Zip ~3 ~--
Zoned
Bonding Company
Bonding Co. Address
City State
Architect/Engineer's Name
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's tAddress
SINGLE FAMILY ~ DUPLEX
MULTI-FAMILY__ HOTEL RETAIL OFFICE
INDUSTRIAL
check one) ,~) --
ESTIMATED VALUE OF CONSTRU6~IONI $ 1"7 ~'' ~
CHECK REVIEWEP~ REJ;RJIRED: - m · - ·, '
~ ~M--~C-~ )(" ~ tSTRUCT~ IFiR~ ~3THERm
Application is here'b-'Crequired 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 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 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 acknowledgemy~t &_..._~ T' e~r ]'ank Name
printed or stamped
Contractor's Signature ~ "~"-~
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this
Falty known to me or who has produced ~
akeanoath. ~ '
Signature of per~¢/i~~~ ' e
printed or stamped
_~ Z'~ 'ogamk-
(Certificate of Corn ~"ff[en_cy Holder)
Contractor's State Certification of Registration No. .
Liability Insurance Expiration Date /4'-~.-
(date) by
of officer
taking acknoxvledgement - typed,
Serial Number, if any __
Date 7--~' - O t
as identification and ~,h~)-dld~
of officer taking acknowledgement - typed,
Serial Number, if any
Workers' Compensation Expiratiorj. Date_ ." 1~]~¢3'T~ ~//~/~,/
Application Approved By ~ (6_~.~..//~._..~ - -- 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\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 RIGliT
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:
VALUATION
FEE
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
Cash Rec'd from: