PERMIT APPLICATIONBP200101
CITY OF BOYNTON BEACH
Application Inquiry
Application number ..... : 01 00003178
Application status, date : FINALED
Property .......... : 1200 OLD BOYNTON RD
PCN ............. : 08-43-45-20-18-000-0000
Lot Number ......... :
Zoning ........... : R3 MULTI FAMILY (10.80)
Application type ...... : FA FIRE ALARM SYSTEM
Application date ...... : 8/07/01
Tenant nbr, name ...... : 1250
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 2070
LOW VOLT FIRE ALARM
WLB
1640
0
Press Enter to continue.
F3=Exit F5=Land inq
F10=Fees Fll=Receipts
F7=Appl names
F12=Cancel
FS=Tracking inq
F13=Val calcs
3/14/02
13:47:01
10/23/01
F9=Bond inquiry
F24=More keys
DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
(Please Print)
COMPLETE EACH BOXED ENTRY
Owner's Name -/f°~//V~'ZA-. M.~ _~,f.~ _~'/~'
Owner's AddressJ /~ ~ ' ~2~ /~~
ICity[ ~ew~ '~~ - / ....... State
Fee Simple ~1~ ~'old~r's ~ame
Fee Simple Title Holder's Add. ss . (If other than owner's)
Contractor's Compan~ ~,~ ~
~Co~act person and emergenc~ phone ~
~paqy Address- ~ /~/~-~
City ~~~ ....... /
~obAddressJ /~ ~-~~~
~Legal Descripti~ - - '
~:,Q" ~:5. (:::~ '?:~. ~_ ':"-/. ?- "~ Zoned
.. , -.City .' ,~ State
Bonding Co. Address ~... ~ .'.:: '~'J,
ArchitecffEngineer's Name ~:
Architec~Engineer's Address
Mortgage Lender's Name ~'
Mortgage Lender's Address
S~GLE FAMILY DUPLEX ~MI~ HOTEL I~TAIL OFFICE INDUSTRIAL
check one)
V*LUE O. CO.SmUCT O.
DEmLED DESC PnON OF WO K:I
VlEWER REQUIRED:
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 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.
Permit#
(FOR SUB PERMITS ONLY)
(Palm Beach County Property Control #)
(If other than owner's)
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 ofpersontaking acknowledgement ~ Name of officer taking ac'knowledgement - typed,
printed or stamped .-~ ,, ..~ ---, ~ ~..~ank ..-~? Serial Number, if any _ _
Contractor's Signature
STATE OF FLORIDA, COUNTY OF PALM BEACH ~/.7/0
The foregoing instrument was acknowledged betbre me this
who is ...... ~r,~w. ,9,0 as oduced
take an ~,al~.' m~._ RICKY AKMUt.~,
Signatu .... [(.--"' I v--er
printed or stamped ~ Title or rank
(date) by
as identification and who did (did not)
Name of officer taking acknowledgement - typed,
Serial Number, if any
(Certif_icat~e of CornpetencX Holder)
Contractor's State Certification of Registration No. ~/~)0~ ~/~_~
Liability Insurance Expiration Date
Workers' Compensation. F~xgk. ettd-~ Date /¢' ,¢ ~"'~ / '~ .-- o (/
Application Approved~ ,,~_.~,4~.t:~-~_~-~t.--.C.-~-..-~ Permit Officer Date:
Any change in building plan os(9.r, eOecifications 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 A.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25/2000