Application Packet-PZ SHED Permit 5-9-17
S:\Planning\Forms\P&Z Applications\Current Style\Fact Sheets\Application Checklists\Sheds.doc 10/11/2011 SHEDS #1 Question: What is the size of the shed? 100 square feet and 9 feet in
height or less will be a P & Z permit process (101 square feet or more and higher than 9 feet will be a Building permit process) You must submit the following items:** 1. 2 copies of
Survey of property. 2. Photos of location. 3. Cut Sheet from manufacturer showing details of construction. 4. May be placed within 3 feet of rear or side property line but may not encroach
into any easement. 5. Proper screening (i.e. trees, shrubs) must be indicated on survey if shed is visible from an abutting property or any adjacent roadway. 6. Permit fee. 7. Completed
Application. ** Submittal requirements will include, but may not be limited to, the above listed documents.
Page 1 of 2 UNIVERSAL COUNTY-WIDE/MUNICIPAL BUILDING PERMIT APPLICATION FORM Approved for use throughout Palm Beach County and Municipalities July 2013 Edition FOR OFFICE USE ONLY FBC
Version:______________ Permit Type: _______________ Accepted By:____________ Application Date: _____________ Application #:________________________________________ 1 KIND of PERMIT □
PRIMARY PERMIT (CHECK ONE): □ SUB-PERMIT -If Fee & Value of a Sub-Permit are covered under a Primary Permit, complete boxes 1, 3, 4, 5, 6 & 8 only to apply. If not covered under a Primary
Permit, complete the entire application to apply. PROPERTY OWNER:_______________________________________ 2 TENANT:________________________________________________ ADDRESS: ___________________________
_________UNIT:______ CITY: __________________________STATE: ______ZIP:__________ PHONE: __________________________FAX:___________________ EMAIL:__________________________________________________
3 TRADE □ STRUCTURAL □ ROOFING □ ELECTRICAL (CHECK ONE): □ MECHANICAL □ PLUMBING □ FIRE □ GAS □ OTHER: _______________________________ PRIMARY PERMIT #: _____________________ PROJECT
NAME: _____________________________________________ 4 PCN: __ __-__ __-__ __-__ __-__ __-__ __ __-__ __ __ __ LEGAL DESCRIPTION:__________________________________________ ADDRESS: ___________________
________________________________ CITY: _______________________________________________________ 5 FURTHER WORK DESCRIPTION Type of Work: □ New □ Addition □ Alteration □ Repair □ Demo
□ Temporary □ Other : ____________________________________________________________________________ VALUE: _____________ PERMIT FEE: ____________ NET S.F (for SFD’s): ____________ (SEE
FEE SCHEDULE) (AS APPLIES) (AS APPLIES) □ 6 OWNER BUILDER PER FL. ST. 489 □ (AS NAMED ABOVE, FOR CONTACT INFORMATION SEE BOX 2) CONTRACTOR DBA (COMPANY NAME): _______________________________________
Contact Person: ________________________________ (CERT. HOLDER): _______________________________________________ License #: ________________________ ADDRESS: _____________________________________STE:
______ CITY: ____________________STATE: ________ ZIP:________ PHONE: ____________________________ FAX: _______________________ EMAIL: ________________________________________ 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 and that all work will be done
in compliance with all applicable laws regulating construction and zoning. 7 ________________________________________________________________________________ (Signature of Owner or Agent)
(including contractor) Print Name NOTARY REQUIRED IF $ 2,500 OR MORE, OR FOR ALL OWNER /BUILDERS REGARDLESS OF $ VALUE STATE OF FLORIDA : _______________________________________ COUNTY
OF _______________________________________ Sworn to (or affirmed) and subscribed before me this _______ day of __________________, 20 , by ____________________________________________________
(Name of person making statement) _________________________________________________ (Signature of Notary Public -State of Florida) (Print, Type, or Stamp Commissioned Name of Notary
Public) Personally Known ____ OR Produced Identification ______ Type of Identification Produced_______________________ 8 ______________________________________________________________________________
__ (Signature of Owner or Agent) (including contractor) Print Name NOTARY REQUIRED IF $ 2,500 OR MORE, OR FOR ALL OWNER /BUILDERS REGARDLESS OF $ VALUE STATE OF FLORIDA : ____________________________
____________ COUNTY OF ________________________________________ Sworn to (or affirmed) and subscribed before me this _______ day of _____________________, 20 _ , by __________________________________
__________________ (Name of person making statement) _________________________________________________ (Signature of Notary Public -State of Florida) (Print, Type, or Stamp Commissioned
Name of Notary Public) Personally Known ____ OR Produced Identification _______ Type of Identification Produced_______________________
Page 2 of 2 FEE SIMPLE TITLEHOLDER, BONDING COMPANY, ARCHITECT/ENGINEER AND MORTGAGE LENDER INFO IS REQUIRED WHEN THE AGGREGATE VALUE (TOTAL COST OF ALL IMPROVEMENTS & NOT JUST WORK
AUTHORIZED BY THE INDIVIDUAL PERMIT) IS $2,500 OR MORE (EXCEPT HVAC REPAIR /REPLACEMENT < $7500). PLEASE ADDRESS ALL ITEMS. 9 Fee Simple Titleholder’s Name ___________________________________________
_______________________ (If other than owner): ____________ Fee Simple Titleholder’s Address (If other than owner): _______ ________________________________________________ City: ___________________
State:_____ Zip: __________ □ Same as Owner 10 Bonding Company ________________________________________________ : ________________________________ Bonding Company Address: _________________________
________________________________________________ City: _____________________ State:_____ Zip: __________ □ Not Applicable 11 Architect/Engineer’s Name ________________________________________________
: ________________________ Architect/Engineer’s Name Address: _________________ ________________________________________________ City: ______________________ State:_____ Zip: __________
□ Not Applicable 12 Mortgage Lender’s Name __________________________________________________ : ___________________________ Mortgage Lender’s Address: __________________________ _____________________
_____________________________ City: ________________________ State:_____ Zip: __________ □ Not Applicable YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. WARNING TO OWNER: NOTICE TO CONTRACTOR: FOR A DIRECT
CONTRACT GREATER THAN $2,500 (EXCEPT FOR HVAC SYSTEM REPAIR OR REPLACEMENT LESS THAN $7500), FLORIDA STATUTES REQUIRE THE APPLICANT TO FILE WITH THE ISSUING AUTHORITY, PRIOR TO THE FIRST
INSPECTION, EITHER A CERTIFIED COPY OF THE RECORDED (BY OWNER) NOTICE OF COMMENCEMENT OR A NOTARIZED STATEMENT (BY OWNER) THAT THE NOTICE OF COMMENCEMENT HAS BEEN FILED FOR RECORDING,
ALONG WITH A COPY THEREOF. IN THE ABSENCE OF A CERTIFIED COPY OF THE RECORDED NOTICE OF COMMENCEMENT, NO SUBSEQUENT INSPECTIONS CAN BE PERFORMED UNTIL THE APPLICANT FILES SUCH CERTIFIED
COPY WITH THE ISSUING AUTHORITY. THE CERTIFIED COPY OF THE NOTICE OF COMMENCEMENT MUST CONTAIN THE NAME AND ADDRESS OF THE OWNER, THE NAME AND ADDRESS OF THE CONTRACTOR, AND THE LOCATION
OR ADDRESS OF THE PROPERTY BEING IMPROVED. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
OFFICE USE ONLY BELOW THIS LINE 13 CODE EDITION/NOTES __________________________________________________ : ______________________________ __________________________________________________
__________________________________________________ __________________________________________________ __________________________________________________ 14 USE □ 1 & 2 FAMILY □ TOWNHOUSE
□ CONDOMINIUM □ MULTI-FAMILY □ □ COMMERCIAL □ INDUSTRIAL (CHECK ONE): □ AGRICULTURAL -BLDG CODE EXEMPT □ OTHER: _____ _________________________________________________ □ USE CHANGE:
___________________________________ ________________________________________________ APPROVED BY:________________________________________________________________ DATE:_____________________________
15 Permit Officer AUTHORIZED FOR CERTIFICATE OF OCCUPANCY: _________________________________________________________DATE:___________________ Building Official or Designee AUTHORIZED
FOR CERTIFICATE OF COMPLETION: ________________________________________________________ DATE:___________________ Building Official or Designee
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561) 742-6260 Fax: (561) 742-6259 S:\Planning\Forms\P&Z Applications\Current Style\P&Z Permit Application
& Forms\Land Survey Affidavit.doc City of Boynton Beach Planning & Zoning Division LAND SURVEY AFFIDAVIT BEFORE me, the undersigned authority, personally appeared, _______________________
(print name), and states: 1. The affiant is over 18 years of age and makes this Affidavit upon his/her own personal knowledge. 2. The affiant is the owner of the property located at
_____________________________________________________________(insert address). 3. The attached survey depicts conditions as they currently exist on the Property as of the date of this
affidavit. The survey shall be clean, legible and clear in detail. Survey shall not bear any previous City stamps. 4. The Affiant warrants to the City of Boynton Beach that there are
no other structures existing on the Property other than those indicated on the attached survey. 5. The The Affiant hereby releases and holds the City of Boynton Beach harmless from any
liability, claim, suits, and/or damages associated with the installation of any improvements on the Property based upon the submission of the attached survey. 6. The Affiant further
warrants and affirms that in the event there are any errors in the survey, or the conditions of the Property are not as indicated on the survey, and additional permits and/or costs are
required, that the Affiant shall assume the obligation to pay for and incur any of the expenses or costs associated with obtaining a new survey or removing any of the structures on the
Property. The Affiant hereby releases the City of Boynton Beach from any responsibility or obligation for any of the costs and expenses associated with the removal or construction of
any structures that are located on the Property which are not indicated on the attached survey or permit. FURTHER AFFIANT SAYETH NAUGHT. _______________________________ STATE OF______________________
__________ Signature _______________________________ COUNTY OF______________________________ Print Name THE FOREGOING INSTRUMENT was acknowledged before me this _ day of ____________
, _______, by _______ , who is personally known to me or has produced ____ as identification. _______ _____ My Commission Expires: ___________________________ NOTARY PUBLIC
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach, FL 33425-310 Phone: (561) 742-6260 Fax: (561) 7426259 S:\Planning\Forms\P&Z Applications\Current Style\P&Z Permit Application
& Forms\Easement Consent & Removal Agreement-forms.doc 10/2014 City of Boynton Beach Planning & Zoning Division EASEMENT CONSENT To: _____________________________________________ Name
of easement holder Address: _____________________________________________ _____________________________________________ _____________________________________________ Gentlemen: I am
the record titleholder of property located at ____________________________________. I propose to apply for a permit from the City of Boynton Beach to construct or install a __________________________
____ in the ____________________ easement on my property, legally described as: Lot _______________ Block _____________ Subdivision ____________________________ or Metes & Bounds ____________________
________________________________________ ____________________________________________________________________________ Please complete the section below indicating your approval or disapproval
of this work. I understand that you will not be responsible for repairs to, or replacement of, any portion of the above referenced improvement and that any removal or replacement of
this improvement necessary for your use or access to this easement will be performed at my expense or my successors in interest. ___________________________________ Owner's Signature
& Date _________________________ Owner’s Phone # ___________________________________ Owner's Signature & Date ACKNOWLEDGEMENT: I/We (agree) (do not agree) to the proposed improvement
under the circumstances described on pages 3 and 4 of this document. _________________________________________________________________________________ Name of easement holder(s) By:
____________________________________ Title: ______________________________ Date: __________________________________ (1 of 4)
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach, FL 33425-310 Phone: (561) 742-6260 Fax: (561) 7426259 S:\Planning\Forms\P&Z Applications\Current Style\P&Z Permit Application
& Forms\Easement Consent & Removal Agreement-forms.doc 10/2014 EASEMENT HOLDERS To assist you in identifying potential easement holders, the following list is being provided. THIS LIST
IS NOT INCLUSIVE AND OTHER ENTITIES MAY HAVE EASEMENT RIGHTS. It is the applicant’s responsibility to identify all easement holders. NOTE: A copy of a survey must be provided with each
consent form when submitting to the easement holder. CABLE: GAS: Comcast Florida Public Utilities WPBReg_IR7090@comcast.com Phone: 832-0872 M-F 8AM-5:30PM, Sa 9AM-1PM Fax: 833-8579 10435
Ironwood Rd M-F 8AM-5PM Palm Beach Gardens, FL 33410 Attn: Engineering Attn: Wade Haggerty 401 S Dixie Hwy. Comcast PBC Construction Dept. West Palm Beach FL 33401 (Allow 1 week for
return fax or email) (Mailing: PO Box 3395, W P B FL 33402-3395 *Do NOT send request via U.S. mail include self-addressed, stamped envelope) ELECTRIC: TELEPHONE: Florida Power & Light
Company BellSouth Telephone /AT&T Phone: 742-2000 Main Contact: 561-357-6410 Fax: 742-2016 Fax: 305-552-5979 M-F 7:30AM-4PM Email: g30576@att.com 9329 S Military Trail Attn: AT&T Boynton
Beach FL 33436 -2901 M-F 8AM-5PM (www.fpl.com) Note: No longer accepting walk-ins or postal mailed requests WATER/SEWAGE: City of Boynton Beach Utilities Dept. Phone: 742-6400 Fax: 742-6299
M-F 7:00AM-4:00PM 124 E Woolbright Road Boynton Beach FL 33426-6040 (2 of 4)
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach, FL 33425-310 Phone: (561) 742-6260 Fax: (561) 7426259 S:\Planning\Forms\P&Z Applications\Current Style\P&Z Permit Application
& Forms\Easement Consent & Removal Agreement-forms.doc 10/2014 City of Boynton Beach Planning & Zoning Division REMOVAL AGREEMENT DATE: PERMIT NO:________________ WHEREAS, ___________________________
____ (hereinafter referred to as “Owner(s)” (Print) is/are desirous of construction or installing a ____________________________________in a portion of the ________________________________
easement on my/our property, the legal description of this property being as follows: Lot _______________ Block ______________ Subdivision ________________________ or Metes & Bounds
________________________________________________________ ________________________________________________________________________ WHEREAS, the Owner(s) does/do covenant that they are
the fee simple owner(s) of the property; and WHEREAS, the above is to be erected for the use and enjoyment or proper functioning of the property and special aesthetics; NOW, THEREFORE,
in the consideration of the City of Boynton Beach (“City”) not immediately enforcing its rights or the rights of any others, now existing or which may in the future exist, against the
Owner(s) or the property, the Owner(s) hereby agree(s) with the City to remove, at no expense to the City, the Easement holders, or the beneficiaries of the easement, the above described
improvement from the property, within thirty (30) days of written notice addressed to them or their successors in interest, at: ADDRESS: ______________________________________________________________
_ _________________________________________________________________________ notifying them that said improvement is inconsistent with the use of the Easement. It is agreed by the Owner(s)
that the improvement shall be as depicted on Exhibit “A” and filed with the City of Boynton Beach Planning and Zoning Division, and that no other construction shall be be in effect in
said Easement. It is agreed by the parties, hereto, that this Declaration will be recorded at the expense of the Owner(s) in the Official Records of Palm Beach County, Florida and that
this Declaration shall be a covenant running with the land and be binding upon the heirs, personal representatives, grantees, assigns and successors in interest of the Owner(s). Owner(s)
shall immediately remove the improvement permitted herein in the event that the City or Owner(s), or both, are challenged with respect to the City’s authority to authorize the placement
of said improvement in the Easement or a claim of damages is made as a result of the placement of said
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach, FL 33425-310 Phone: (561) 742-6260 Fax: (561) 7426259 S:\Planning\Forms\P&Z Applications\Current Style\P&Z Permit Application
& Forms\Easement Consent & Removal Agreement-forms.doc 10/2014 improvement in the Easement. In the event that the City and/or Owner(s) are challenged with respect to the placement of
said improvement in the Easement, or a claim for damages is made as a result of the placement of said improvement in the Easement, Owner(s) shall indemnify, defend, and save the City
harmless against and from said challenge. Upon the vacation, abandonment or discontinuance of the Easement, this Declaration shall immediately and automatically terminate and be of no
further force and effect. SIGNED, SEALED, EXECUTED AND ACKNOWLEDGED on this _________________ day of ___________________, ________. WITNESS: ________________________________ _________________________
__________ Owner’s Signature ________________________________ ___________________________________ Owner’s Signature ________________________________ Owner’s Phone # STATE OF FLORIDA
COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this ___________________ day of _________________________, ________, by ___________________________________ (Name
of Person Acknowledging) who is personally known to me or who has produced ______________________________ (Type of ID) as identification and who did/did not take an oath. (Signature
of person taking acknowledgement) (Name of Officer taking acknowledgement typed, printed or stamped) (Title or rank) (Serial number, if any) SEAL (4 of 4)