PERMIT DOCUMENTS •
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AFTER RFrORDINO-REr11PNTO
CFN 20160095491
OR BK 28174 PG 1064
/6 - 0000 I/3D RECORDED 03/21/2016 11:40:33
PERMIT NEMER Palm Beach County, Florida
NOTICE OF COMMENCEMEN7.Sharon R. Bock,CLERK & COMPTROLLER
Pg 1084; llpg)
The undersigned hereby gives notice that improvanent will he made to certain real property,and in aaadance with Chapter 713,
Florida Statutes,the following information is provided in this Notice of Commencement_ �` l.1 e 2� ("G`�
L DESCRIPTION OF PROPERTY(Legal desoiptimdthe pop my 8 e,edaddlm,if irrigable)TO VOUO NO.:GS 3 Si'S.3.3 Ck Cato
- .6DaoIYISIDe ecLc_r est ®.00T( TRACT LOT
LOTBLDGUNITT_
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L .0640IPTION OF U nOVD urr•^iact ,l••.gYCA.� " dR`c r.
• 3. OWNER RTORMATON OR LEINiD° nOn riff LESSEE coDR Tilt rIT L i
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b Warm in:raptor 0...B XLrel—
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A. a.CONTRACTOR'S 't'S'NOt.r 1 Lv _Ira
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c`,+A OFFICE USE ONLY
CITY OF BOYNTON BEACH REV#
ate DEVELOPMENT DEPARTMENT I BUILDING DMSION
e 100 East Boynton Bach Boulevard•Boynton Beach,FL 33425•(561)7424350•Fax 7424357
or
PERMIT REVISION APPLICATION
NOTICE: This revision application must bear the signature of the primary contractor. If
the scope of work is increasing to include a trade not shown on the original plans, the
corresponding subcontractor's signature is also required.
THIS REVISION IS FOR 0 Changes to Plans Additional Work
Permit# /lP - ff3 o Project Name /vac SE a,-? (a 447
Job Address iY SC 27 wn 13x,5,,,o„ I'3c4� Unit#
Primary Contractor(or Owner/Builder) 2 n- enns-rel44.44 o^ License No.
Address ?loo P/AC/ick. City, State,Zip 642i.,,� 3 4j 33te_7s-
Contact Name Ales Phone I sit _ zip 3_83 Email Ake yak P 1^.,pq,.Car�
Subcontractor Name(if applicable) r'3cgsea c r Owrd e, fey;Y,t_r (le_ License No. u—21 Tao
Address 731 .2 CblovA to(ar D a . City, State, Zip sotto+. be4., FL 33y3
Contact Name mon l tesa, S Phone S(,( 9c/ o9Fc Email ac3/>u.rSei„✓cAxe4n4C.G,•.—
Description of Proposed Revision, 6 t' `c, ,"4^3 Speon A S,, c.• lug( d// Meal Cr)P•-r.
Trades Affected(check all that apply): ❑ Building 0 Roofing 0 Electrical
❑ Mechanical 0 Plumbing 0 Gas 0 Fire Protection Other: it rNV•iiir
Value of Proposed Revision 01 /c c 0 I Revision Fee(office use only)
NOTE: Revision Fee=Value of Proposed Revision x 0.023,or$75+$10 per page,whichever is greater.
I, the undersigned, am applying for a revision to the approved plans as indicated on the accompanying construction
documents.I understand that it isOlyres ibility to have the approved construction documents on site for inspection.S
Primary Contractor's Signature �{/Lf' '�f Subcontractors Signature /'
(Notary required if ue exceeds$2,500.) (Notary requlr if\ lu I coeds$2,500.)
STATE OF COUNTY OF STATE OF COUNTY OF
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day of ,20 day of 20
by (pont signers name), by @1A21 sirecs name),
who is personally known to me or who has produced_ who is personally known to me or who has produced
as identification,and who did/did not take an oath. as Identification,and who did/did not take an oath.
Notary's Signature,Printed Name I Seal Notarys Signature,Prided Name&Seal
5:\Development\BUILDING\Form s-Templates-Signs\Permit Revision Application.docx