PERMIT DOCUMENTS UNIVERSAL COUNTY-WIDE/MUNICIPAL FOR OFFICE USE ONLY
BUILDING PERMIT APPLICATION FORM FBC Version: Permit Type:
July 2013 Edition Accepted By: Application Date:
Approved for use throughout Palm Beach County and Municipalities Application tl:
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KIND of PERMIT(CHECK ONE): PROPERTY OWNER:BOYNTON SHOPPED LLC
❑ PRIMARY PERMIT TENANT: -4 alp clef nn,-k
• SUB-PERMIT-If Fee&Value of a Sub-Permit are ADDRESS: 3700 AIRPORT ROAD UNIT: 2
covered under a Primary Permit,complete boxes1,. 3 4,S.6 & gOCA RAroN FL 33431
8 only to apply.If not covered under a Primary Permit, CITY: STATE: ZIP:
complete the est a applications to apply. PHONE: 5 ko1" 12 5 . S \ 1 FAX:
I f taa7t( €(YYI\k .fr 1 lD - ` I EMAIL: C 3F Dora X10 4nw , co
3 4
TRADE (CHECK ONE): PROJECT NAME: JUPITER DONUT FACTORY
o STRUCTURAL o ROOFING I ELECTRICAL PCN: 0 8 _ 4 S a s _ 3 2 _ o o .o 0 0 . 3 0 4 0
o MECHANICAL o PLUMBING o FIRE 0 GAS
o OTHER: LEGAL DESCRIPTION:
PRIMARY PERMIT#: 161060 ADDRESS: 2260 W WOOLBRIGHT ROAD 42
CITY: BOYNTON BEACH
I
FURTHER WORK DESCRIPTION: ELECTRICAL FOR HOOD EQUIPMENT
Type of Work: 8 New o Addition o Alteration o Repair o Demo o Temporary, o Other
T
VALUE: - PERMIT FEE: NET S.F(for SFD's):
(SEE FEE SCHEDULE) (AS APPUES) IAS APPLIES)
6
0 OWNER BUILDER PER FL.ST.489(AS NAMED ABOVE,FOR CONTACT INFORMATION SEE BOX 2)
• CONTRACTOR(CERT.HOLDER): BARRY SEIFER License#: EC19006129
DBA(COMPANY NAME): CORAL ELECTRIC Contact Person: BARRY SEIFER
ADDRESS: 6919 TURTLEBAYTERR STE: CITY: LAKE WORTH STATE: F- ZIP:33463
PHONE: 661-729-0601 FAX: 561-7290641 EMAIL: INFOOCORALELECTRIC.COM
Application is hereby made to obtain a permit to do the 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 laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL
WORK, PLUMBING,SIGNS,WELLS, POOLS, FURNACES,BOILERS,HEATERS,TANKS, and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate an• at all work will be done in compliance
with all applicable laws regulating construction and zoning.
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s_� ice/ a
;signature of Owner or Agent:(Including contractor) (Stena re of Owner or Agent)(Including( ng contractor)
Print Name: clr v�QLSeaJ\CJI Print Name: Barri'Seiler
NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/ NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/
BUILDERS REGARDLESS OF$VALUE STATE OF FLORIDA BUILDERS REGARDLESS OF$VALUE STATE OF FLORIDA
COUNTY OF uW52-D COUNTY OF ?"i'o,-JCJ_GQ
Sworn to(or affirmed)and subscribed before me this 5 t Sworn to(or affirmed)and subscribed before me this ST"
day of etan \ 20 llo ,by day of ccacL 1 20 \LC? ,by
EU lheywoSCAJ\ckl AnNt 3 FF4
(Name of person malung statement
(Name person making tatement)
(signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
(Print,Type,or Stamp Commissioned Name of Notary Public) (Print,Type,or Stamp Commissioned Name of Notary Public)
Personally Known iC OR Produced Identification
Personally KnowniC OR Produced Identification
Type of Identification Produced
Type of Identification Produced
; 'p OUMENICO CAMARDA 001IEN1cv t;ANiARUA
MY EXPIRES
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EXPIRES August 12.2019 • EXPIRES August 12.2019
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3810 NW 5th Court• Ft Lauderdale, FL 33311 • Phone(754)235-7126• Fax(954)306-3710
NOTICE OF TERMITE PROTECTION TREATMENT
As Required By Florida Building Code (FBC) 104.2.6
Property Information Builder/Contractor
Treatment Date '9/29'//4 Name of Builder
Treatment Time //Z•V Hot/
Lot Shell Contractor
Block
Subdivision Name 1[� �� CONSTRUCTION TYPE:
Street Address '2, 26gbh t^G 13�g/' A Monolithic 24) S/F OF
Stemwall S/F OF
City/State/ZipbAIDN �JL-ff'Patio S/F UF
Additions S/F OF
CHEMICAL TYPE: liettcper To Cypermethrin
• Termidor Fipronil O Dragnet Permethrin U SS ray Only
U Pro Build TC Cypermethrin l]Permise Pre-Construction a spray and Tamp
❑ Other Imidaclrid ❑ Re idential
//- mmercial
TRFATMENTTYPE: Cs Chemical l °k
Underslab Date of ompl tion
hooters Gallons 1O % /
❑ Wood Treatment 3 e9 j6
Applicator v LA.,
GUARANTEE RENEWAL
❑ None ❑ Yes
❑ 1 Year O No
U 5 Years
NO LIMIT TERMITE&PEST SERVICES, LLC. hereby confirms that this building has received a complete treatment for the
prevention of subterranean termites.Treatment is in accordance with the rules and laws as established by Florida Depart-
ment of Agriculture and Consumer Services. Exterior perimeter treatment was completed upon final grade.