APPLICATION
, iJV/
~' )Jj ~.~
/1 j \jv "I '~
Y Yl' ti ' . if\ . f\ '
h r)/J I \;vL\; ,~ 1 O)A
). , " tfU - \If'--~{\ ylJ(J" ~
n /~~' tl ) Jv.[V
v L.'l),lj
.Vi tV' -
INSPECTION DEPOSIT REFUND V 1;~''vW ~.j,~
The City of Boynton Beach
DEVELOPMENT DEPARTMENT
PlANNING AND ZONING DMSON
100 E. Boynton Beach Boulevard
P.O. Box 310
Boynton Beach, Florida 33425-0310
TEL: 561-742-6260
FAX: 561-742-6259
www.boynton-beach.org
Date: 5 - I <i) - ('cr
.~d~~
SIte: ....~ '_:":~' (p A .:3 l-q ~
Address:H.~x.3H...~.E-.Z:... ,.. ..' .,. .. ,.
Property Owner: ..................,... ~
~.~..~.L:ftLw~~
1, , acknowledge receipt of the inspection deposit refund, check # .:22.90
drawn on the account of said Contractor in the amount of $500.00 for the above- referenced site.
Print Name
Signature
')
" ') he np (60. l---e
~.
Planning & Zoning Print Name
<f)U:.'/(Aj () rtJ~ Signature
./'
GOLDSMITH DENTAL LAB., INC.
207 SE 23RD AVE.
BOYNTON BEACH, FL 33435_7~
r;~bJI? 6~E L'.I 7 d I If- /Je~4
ft (/-e- '-)/vr, ~ J
/'
/
.r'
I' ~,r
MEMOIVJrcA'1^- 'r~/j
II- 0 0 2 2 ~ 0 II- I: 2 b 7 0 B ~ 7 b ~ I:
2290
BANKATLANTlC
BOYNTON BEACH
BOYNTON BEACH, FL 33426
VDID
63.8376/2670
151
//
DOLLARS
~/ ';;tt. / LdJ'-.
- -----~~~----~
00 5 5 B l. b II-
Total Project Cost
Estimate:
I
City Codes Accessed via Website www.boynton-beach.org
www.amlegal.comlboynton_beach-fl.us
CITY OF BOYNTON BEACH, FLORIDA
PLANNING & ZONING DIVISION
MINOR LANDSCAPE PLAN MODIFICATION
This application must be filled out completely and accurately and submitted to the Planning and Zoning
Department. Incomplete applications will not be processed.
GENERAL INFORMATION:, ~ ~\J
oX 1. Project/Business Name & Street Address G () \ck,.,I t, ~ \ t\ L.
I), b (A... 1'U.t-
""y -/ S C ).. ~ /' rY.r
f? ~ ~L- ~.,,*~)
I.
K2,
Applicant's Name & Address (pe son or business entity in whose name this application is made):
J-e~S~ Go IJi",,+I( 6DIJiiHr#2.. ~~ Ll\8 ft1c..
Phone: 5\? \ 13(" ~'l \0
Fax: ~l ~ 1to glfY I
Proposed Landscape Plan - 60 % Native species required for Replacement Trees.
a. Detailed description of new landscape plan showing all tree species.
b. Symbol for trees removed,
c. Total caliper inches of trees removed.
d, Symbol for tree replacements.
e. Total caliper inches of replacement trees.
Is this work the result of a code enforcement action?
Name of citing code enforcement officer:
Do you require a permit for other site work (i.e. Irrigation)? _Yes V-No
L",,^hL~Z.
Yes VNo
Name of Removal Company: 05~u21V"'~
R
E
M
o
V
A
L
Qty Species Height Trunk Caliper MonthlY ear of
" Removal
~ BI~ k O\lv'-t }~\ ~D" -{M ? t11
Total Tree
Caliper Inches -+ -+ -+ -+ -+
Start of Removal: MonthlYear:
Completion of Removal: Month/Year:
Gross Time Frame for removal:
,.
Minor Landscape Plan Modification Application
CALL FOR INSPECTION UPON START OF REMOVAL: 742-6265
Name of Replacement Company: bSu,r !;.-Iljfr"" LiJ-.J~, f 11'1 r--
R
E
P
L
A
C
E
M
E
N
T
Qty Species
Height Trunk Caliper Month Near of
Plantin
--i 'f- .Z'
Lj/
Iv'fY\. ) -2/ 1"2:
Total Tree
Caliper Inches -+ -+ -+ -+
-+
31/
Start of Planting: MonthlYear:
Completion of Planting: MonthNear:
Gross Time Frame for Replacement:
Call for inspection upon start of Replacement: 742-6265
ALL CONTRACTORS HIRED FOR SERVICE MUST HA VE OCCUPA TlONAL LICENSE IN THE
City Of Boynton Beach AND PROVIDE PROOF OF INSURANCE.
I OL# C 9 r 2#24
2
Minor Landscape Plan Modification Application
CALL FOR INSPECTION UPON START OF REMOVAL: 742-6265
Name of Replacement Company: (jJJ5~~ ~?L-
R
E
p
L
A
C
E
M
E
N
T
Qty Species Height Trunk Caliper Month /Year of
Planting
I ~~I f'~ 1./1 --,// 'j "1
~ "J
'-/~ , r
_I c:: 1-'"2...
I r; fl e-.f -1<-
'1 '16-k/'/tkt "
'"Zx.zl
~r:; ~7I-Ic,'/ ~hs Lfl 3'"
<6 &o[) flhl'J ' .
ZX'2/
/ cf - '"Z.x -2-
~/Q(t;5
Total Tree
Caliper Inches -. -. -. -. 02-\ \ V
-.
Start of Planting: MonthlYear:
Completion of Planting: Month/Year:
Gross Time Frame for Replacement:
Call for inspection upon start of Replacement: 742-6265
ALL CONTRACTORS HIRED FOR SERVICE MUST HA VE OCCUPA TlONAL LICENSE IN THE
City Of Boynton Beach AND PROVIDE PROOF OF INSURANCE.
IOL#
2
.
Minor Landscape Plan Modification Application
VI. CERTIFICATION
(I) (We) understand that this application and all papers and plans submitted herewith become a part of
the permanent records of the City of Boynton Beach, (I) (We) hereby certify that the above statements and any
statements or showings in any papers or plans submitted herewith are true to the best of (my) (our) knowledge
an elief. This PRlication will n~ be accepted unless signed according to the instruc' ns ~elow.
~ \\\D;
Si ature of Owner(s) or Trustee, or Authorized principal if Date
property is owned by a corporation or other business entity.
){ ~LSSL C e> \~~VV\,-f€-
Print name
or
Letter of Authorization from Property Owner
Fee Schedule
Estimated Value of Improvement: < $5,000.00 = $100.00 ~
> $5,001.00 = $200.00--=lrJ>
Inspection Deposit:
$500.00
~
---
Two separate checks are required. The Inspection Deposit fee is refundable upon
completion of a successful final inspection (no later than 60 days from
commencement). In the event that the applicant fails to call for a timely (60 days) final
inspection, the deposit amount will be forfeited and an inspection will be completed by
the forester at that time.
3