PERMIT APPLICATIONBP200101
CITY OF BOYNTON BF2%CH
Application Inquiry
4/09/02
07:59:05
Application number ..... : 01 00000029
Application status, date : FINALED
Property .......... : 902 SW 5TH CT
PCN ............. : 08-43-45-29-05-020-0080
Lot Number ........ :
3/29/02
Zoning ........... : R1AA SINGLE FAMILY (5.40)
Application type ...... : PS PATIO SLAB
Application date ...... : 1/03/01
Tenant nbr, name ...... :
Master plan nbr, revwd by :
Estimated valuation .... :
Total square footage .... :
Public building ...... : NO
Work description, qty . . . :
Pin number ......... : 3567
PATIO FRONT/DECOR BLK
RA
1650
0
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DEPARTMENT OF DEVELOPMENT 0 1 - 0 0 2 9
BUILDING DIVISION
BUILDING PERMIT APPLICATION Rec. #
~~ Permit # ~;~fr_ O00Z_TFOR
SUB
PERMITS
ONLY)
PCN# /~ t-t/~5/~ .9..~ 0~' OZO 09 ~D (Palm Beach County Property Control #)
Owner's N~me t~7 ! ~./-/ /':] ~ O I~/ / ./- ~-' "~.~ ]'~ ~ Owner's Phone #
Owner's Address ~ ,~
City
Fee Simple Title Holder's N~-me
Fee Simple Title Holder's r~ddre~s
Contractor's Company t,~¢~-'~
Contact person and emergency phone #
Company Address ,c~
City ~ ~'~'_
me "( '- - '
Job Na .~..~.~.~ .r_/
Job Address " ~ ~
Legal Description
State
Company Phone #
Zip
(If other than owner's)
(If other than owner's)
Pager/Fax#
State .,C'4.~ Zip
Zoned
Bonding Company
Bonding Co. Address
Architect/Engineer's Name
city
State
Architect/Engineer's Address
Mortgage Lender's Name
Mortgage Lender's A. ddr~s
SINGLE FAMILY ~ DUPLEX __
MULTI-FAMILY
HOTEL RETAIL OFFICE INDUSTRIAL
(check one)
ESTIMATED VALUE OF CONSTRUCTION
DETAILED DESCRIPTION OF WORK:
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 TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN A'I-rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT,
Property Owner's or Agent's Signature ~....~j _/'~_~ ~/ 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 acknowledgement
printed or stamped Title or rank
Contractor's Signature ~ //~.~.~ _. f-~_~¢,~¢.
Name of
officer taking acknowledgement - typed,
Serial Number, if any __
Date ,,,/-",.~ ~...'~ /
whc~isThe foregoing instrument was acknowledged before me thiSpe_rso, allv known to me or who has p..roduced ' j' %(.~_ (date) b k"3 as ident~fic~'~°n and wh° di~t (did n°t)
take an °aCt'g"%'C~ristine C°nk"n"'~ ~ / \.~~~ 0 ~f
(SEAL) '%.'~,~/ExpOs September 10, 2001 \
S~g~ature o~'I~';rson takLng acknow]edgcmen~ officer taking acEnowledgement - typed,
prated or stamped " Title or rank Serial Number, it' any
(THIS SIDE FOR OFFICE USE ONLY)
APPLICATION ~ '
APPLICATION DATE:
SETBACKS:
ZONE:
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 (NC)
# 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:
SINGLE FEE
Building
Cleadng & Grubbing
Drainage
Electdcal
Excavation
Fill
Fire Alarm
Fire Sprinkler
Irrigation
Landscaping
Mechanical
Paving
Paving/Drainage
Plumbing
Roofing
Sign
Site Lighting
VALUATION
FEE
SUB TOTAL
TOTAL
LESS PLAN FILING FEE
(ACCEPTED BY STAFF__
TOTAL AMOUNT DUE
(INITIALS)
RECEIPT NUMBER
IF THIS BOX IS NOT COMPLETED, THIS PERMIT IS SUBJECT
TO A FINAL INSPECTION ONLY.
AUTHORIZATION for CERTIFICATE OF OCCUPANCY:
Date
AUTHORIZATION for CERTIFICATE OF COMPLETION:
Date
J:\SHRDATA\DEVELOPMENT~FORMS.DOC\PERMIT APPLICATION.DOC - Revised 6/18/97, 11/4/97, 12/98, 6/99, 8/99, 5/00, 8/00, 9/25~2000