PERMIT DOCUMENTS ,T rQn
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CITY OF BOYNTON BEACH
DEVELOPMENT DEPARTMENT I BUILDING DIVISION
olir u 100 East Boynton Beach Boulevard•Boynton Beach,FL 33435•(561)742-6350•Fax 742.6357
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APPLICATION FOR: ❑ EXTENSION 8 **REINSTATEMENT
SELECT ONE: iU Permit ❑ Permit Application (max of(3)three extensions)
Project Name:Convo4e raft 4,72.,,,o-
Permit # 1200001655 Job Address: 2180 Hypoluxo Road
Contractor of Record: Spectrum Cable Corp
Phone: 561 641 3399 Email: americanlighting@gmail.com
MaiIin9 Address: 345 Swain Blvd
City Greenacres State: Fl Zip Code: 33463
Detailed reason for the extension: Final Inspection of trash compactor motor replacement to 3 phase
with new 3 phase 30 amp raintight disconnect
I, the undersigned, am requesting an extension/reinstatement for the item indicated above. I understand that
submittal of this form does not constitute in itself approval of the extension/reinstatement.
Qualifier/Authorized Agent Feb 11,2016
Signature Date
Terry Stuart
Printed Name
FOR OFFICIAL USE ONLY
i1/4Date of Expiration:vi\v m\` \� Processing Technician Initials: \
Application Extension(max of(3)three extensions): 01"$50.00 ❑2n°$75.00 Et$100.00
Permit Extension: ❑1"$50.00 ❑2nd$75.00 ❑P$100.00 ❑Extension beyond 90 days$250.00(Requires
Building Board of Adjustment&Appeals Approval)
Permit Reinstatement Fee: Total Permit Value: IyK(.9
Under 180 days of inactive status ❑0 575.00 limes 2.3%
Over 180 days of inactive status AY $75.00 or Permit Fee: 5-5.41
Over 180 days of inactive status 0 30% limes 30%
(Whichever is greater) Reinstatement Fee: I)' Jt)
a Approved,extended for 3 O days CIDenied "Additional Impact Fees may apply
Sr
`eyi- -. .y : . : 1 -icia Date
S:\Development\BUILDING\Forms-Templates-Signs\Application for Extension-REVISED 1-20-2016.docx