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17-2376 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 U: 3 3 - KIND of PERMIT(CHECK ONE): PROPERTY OWNER:John T.Franck ❑ PRIMARY PERMIT TENANT: ❑SUB-PERMIT-If Fee&Value of a Sub-Permit are ADDRESS: 949 Brookdale Dr. UNIT: covered under a Primary Permit,complete boxes.3 4,5,6 & Boynton Beach FL 33435 8 only to apply.If not covered under a Primary Permit, CITY: Y STATE: ZIP: complete the entire application to apply. PHONE: 954-993.5991 FAX:561-912-4562 EMAIL:tfranck©jardencs.com 3 4 TRADE (CHECK ONE): PROJECT NAME: Home Remodel o STRUCTURAL o ROOFING o ELECTRICAL PCN: MECHANICAL o PLUMBING o FIRE o GAS o OTHER: LEGAL DESCRIPTION:Single Family Home rcR 37/o ADDRESS: 949 Brookdale Dr.,Boynton Beach,FL 33435 PRIMARY PERMIT#: l CITY: Baynton Beach I FURTHER WORK DESCRIPTION: Add one bathroom and remodel/update one existing bathroom and two existing bedrooms. Type of Work: o New o Addition o Alteration o Repair ❑Demo o Temporary o Other VALUE: PERMIT FEE: NET S.F(for SFD's): (SEE FEE SCHEDULE) IAS APPLIES) IAS APPLIES) 6 IA OWNER BUILDER PER FL.ST.489((ATS NAMED ABOVE,FOR CONTACT INFORMATION SEE BOX 2) 13—CM M— I€18 2.......yy CONTRACTOR(CERT.HOLDER):/—aUAW,..,� ' A�'t - License It:. DBA(COMPANY NAME): W D16 lit t.w4rt ItDa CITY: f act Person: w n,1 ADDR/E1SS: q.,,84- Oa/JAW, STE: CITY: Or t eilf.)0 C An-I STATE: et , ZIP:3306-4, PHONE: Ct5Li— 1751 - ObZ* 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 .pplicable laws regulating construction and zoning. - .i °i/ i•.. -. a of Owner or Aernt)(including,tram«) Mr.... re04 Oyer«Ment)(mnadW Mndan Print ame: john T.Franck Print Name: ariWirtsf C—hknikent..40 - OT• ' REQUIRED IF$2.500 OR MORE.OR FOR AU.OWNER/ NOTARY REQUIRED IF$2.500 OR MORE,OR FOR ALL OWNER/ B ERS REGARDLESS OF$VALUE STATE OF FLORIDA BUILDERS REG'A,BQL�ESS OF$VALUE STATE OF FLORIDA COUNTY OF Palm Ben COUNTY OF l'Sr.(\ .yCNC TM yy�� Sworn to(or affirmed)and subscribed before me this 18th Sworn to rffi )and subscribed before me this GC.T'). day of August/ 17-q- O 20 17 -by day of C' J( 1 20 1✓7 ,by r� pLm�pa rJmeury/>6f_am/)nt1�D'Z IRem.«person(Aa Cf mLI t I,I J z ) (Sign re of Notary Public-Stat f Florida) (Signature of Notary Public•State of Florida) (Print,Type,or Stamp Commissioned Name of Notary Public) (Print,Type,or Stamp Commis oned Name of Notary Public) Personally Known_OR Produced Identification ‘•"------ Personally Known R Produced Identification I/ Type of Identification Produced FG- b L TYfluaf.'d _.:f _. -- - -.4 U_e.a}_ko-ZE/3--0 TINA N.COW �' MY cuACA,n iOrsIG0 a tUtu "M NARMEI PELZ 07:4.17S) EXPIRES lbranm31),2029Page 1 of 2 -' MY COMMISSION Y FF935034 '• BaSed TIw NCary Put*enfant s EXPIRES January 29.2020 +� 1041441] Iscalanlininnan con 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. s � Fee Simple Titleholder's Name(If other than owner): Bonding Company: Fee Simple Titleholder's Address(If other than owner): Bonding Company Address: City: State:_Zip: _ City: State:_Zip: o Same as Owner o Not Applicable U Architect/Engineer's Name: Mortgage Lender's Name: Architect/Engineer's Name Address: Mortgage Lender's Address: City: State:_Zip: City: r State: Zip: o Not Applicable o Not Applicable _ WARNING TO OWNER: 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. 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 u 2 CODE EDITION/NOTES: USE(CHECK ONE): ❑ 1&2 FAMILY ❑TOWNHOUSE 0 CONDOMINIUM o MULTI-FAMILY o COMMERCIAL ❑INDUSTRIAL o AGRICULTURAL-BLDG CODE EXEMPT a OTHER: o USE CHANGE: Js APPROVED BY: DATE: Permit Officer AUTHORIZED FOR CERTIFICATE OF OCCUPANCY: DATE: Building Official or Designee AUTHORIZED FOR CERTIFICATE OF COMPLETION: DATE: Building Official or Designee U, I. Ir I M M ) , 5.._, PI �< � u r S J A 4 ii;1 N.t a. pie"Vs ,4 44)6 ..:roij:. v