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APP-BuildingNEW CONSTRUCTION & ADDITIONS - FEE SCHEDULE I* TOTAL COST OF CONSTRUCTION TO INCLUDE: STRUCTURAL, ROOFING, ELEC, MECH, PLBG $____________________ NOTE: OTHER ASSOCIATED TRADES TO BE FEE’D SEPARATELY UNDER FEE SCHEDULE II OR III. THESE INCLUDE: LOW VOLTAGE, HOOD/SUPPRESSION SYSTEM, FIRE SPRINKLERS, IRRIGATION, LANDSCAPING, PAVING, ETC. MISCELLANEOUS PERMITS – FEE SCHEDULE II* ALTERATIONS & GENERAL CONSTRUCTION –SCHED. III* TOTAL COST OF CONSTRUCTION: $___________________ COST OF CONSTRUCTION WITHOUT TRADES: $___________________ NOTE: ALL SUB-TRADES TO BE FEE’D SEPARATELY. THESE INCLUDE ELEC, MECH, PLBG, ROOFING, LOW VOLTAGE, HOOD/SUPP SYSTEM, FIRE SPRINKLERS, IRRIGATION, LANDSCAPING, PAVING, ETC. *SEE BUILDING PERMIT FEE SCHEDULE FOR DETAILS -1- APPL DATE F.B.C. VERSION ACCEPTED BY PERMIT NO. OWNER INFORMATION CONTRACTOR & DESIGNER INFORMATION Name ________________________________ Address______________________________________ City ___________________ State_____ Zip_________ Home Phone ( ) ___________________________ Cell Phone ( ) ___________________________ Fax No. ( ) ___________________________ Email Address _________________________________ Check if Owner/Builder (See Page 3) Contractor License No.__________________________ Workers’ Comp No. _____________________________ Company _____________________________________ Address ______________________________________ City ____________________ State_____ Zip_________ Phone __________________ Fax _________________ Cell ____________________ Email ________________________________________ Architect/Engineer’s Name _______________________ Address ______________________________________ Private Provider: Plan Review ____ Inspections ____ ****************************************************************************************** FOR PERMIT EXPEDITERS ONLY (for permit pick -up): Contact Name _________________________________ Phone ____________________________Ext. ________ Cell _______________ Email _____________________ PROPERTY INFORMATION Property Control Number: ___-_____-_____-_____-_____-_____-_____ Address of Proposed Work _____________________________________________ Legal Description _______________________________ Suite or Apt # / Floor _____________________________ Project Name (if applicable) _______________________ Flood Zone _____ ADDITIONAL INFORMATION Fee Simple Title Holder (if other than owner) __________________________________________________________ Address ________________________________________ City_________________ State __________Zip ________ Mortgage Lender _________________________________ Bonding Company _______________________________ Address ________________________________________ Address _______________________________________ City _____________________ State ______ Zip ________ City ___________________ State ______ Zip ________ DESCRIPTION OF PROPOSED IMPROVEMENTS Detailed Scope of Work (New Construction, Addition, Interior/Exterior Alteration, Windows/Doors, etc.) _____________________ ________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Is this a City or Re-hab project? Yes No Is the building served with an automatic fire sprinkler system? Yes No Current Use or Occupancy ___________________________ Is this a change in the Use or Occupancy? Yes No PERMIT VALUATION For Impact Fee Credit, Existing or Previous Structure Demolished? Yes No Type of Structure Demolished: SFR Commercial Commercial Accessory Building PLEASE CHOOSE ONE OF THE FOLLOWING: BUILDING PERMIT APPLICATION 100 NW 1st Avenue ▪ Delray Beach, FL 33444 (561) 243-7200 ▪ Fax (561) 243-7221 www.delraybeachfl.gov MY BODYWORKX CHIROPRATIC LLC 14560 S MILITARY TRAIL B4 DELRAY BEACH FL 33445 561 246-1143 ACCFERN@ME.COM CBC1260546 ADVANCED BUILDING CONTRACTORS INC 10309 ALLEGRO DR BOCA RATON FL 33428 561.599.0767 PERMITS@ADVBUILDING.COM STEVE SIEBERT ARCHITECTURE 1010 GATEWAY BLVD, SUIT 103 BOYNTON BEACH, FL 3342612 42 46 13 35 001 0010 14560 S MILITARY TRAIL B4 DELRAY SQUARE 2 B4 MYBODYWORKX RENO@14530 INTERIOR REMODEL, FRAMING, DRYWALL, FLOORING, PLUMBING, ELECTRICAL APPLICATION CERTIFICATION AND ACKNOWLEDGEMENT Application is hereby made to obtain a permit to do the work and installation 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. A City Building Permit does not assure compliance with Homeowners Association’s rules, regulations and/or deed restrictions. Applicant is advised to obtain approval from the Homeowners Association before improving any property. Applicant further acknowledges the following: •Separate permits must be secured for ELECTRICAL, PLUMBING, MECHANICAL, WELLS, POOLS, FIRE SPRINKLER, SIGNS, LANDSCAPE, IRRIGATION, ROOFING, SHUTTERS, ETC. •This permit becomes null and void if work or construction authorized is not commenced within six (6) months or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is co mmenced. Permit will be considered suspended or abandoned if it does not pass an inspection within 180 days and will be subject to a reactivation fee in the amount in force at the time of reactivation. •Failure to comply with all applicable construction regulations may result in the withholding of future permits. •Submission of any false information or misrepresentation is a violation of law and shall result in revocation of your permit. •NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. 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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT . OWNER’S AFFIDAVIT: I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. PROPERTY OWNER or AGENT (Including Contractor) STATE OF FLORIDA, COUNTY OF PALM BEACH ___________________________________________ Signature of Owner or Agent (Including Contractor) ___________________________________________ Printed Name of Owner or Agent (Including Contractor) STATE OF FLORIDA, COUNTY OF PALM BE ACH The foregoing instrument was acknowledged before me by means of [ ] physical presence or [ ] online notarization This _______ day ____________________, 20 _____, By _________________________________________. _____Personally Known OR _____Produced Identification Type of Identification: _________________________ __________________________________________ Signature of Notary (SEAL) -2- GENERAL CONTRACTOR STATE OF FLORIDA, COUNTY OF PALM BEACH ___________________________________________ Signature of Qualifier ___________________________________________ Printed Name of Qualifier STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me by means of [ ] physical presence or [ ] online notarization This _______ day ____________________, 20 _____, By _________________________________________. _____Personally Known OR _____Produced Identification Type of Identification: _________________________ ___________________________________________ Signature of Notary (SEAL) ELIOMAR LIMA JR Revised 05/19/23 1 of 2 •THIS PAGE FOR BUILDING DEPARTMENT USE ONLY• PERMIT NO: ________________________ APPLICATION DATE: _________________________ PCN: _____ - _____ - _____ - _____ - _____ - ________ - _________ Zoning District __________________________________________________ Historic: □ Yes □ No Development/Condominium/Apartment Name ________________________________________________________ Set Backs: Front _______________ Side Street _______________ Side Interior _______________ Rear _______________ Type of Foundation: Monolithic _____ Stem Wall _____ Pile _____ Square Footage of Commercial Demolition: ________ Type/Size of Accessory Building: ______________________________ Type of Structure Demolished: SFR Commercial Commercial Accessory Building STRUCTURE SET UP Occupancy ___________________________________________ Const. Type __________________________________________ Roof Type ___________________________________________ Flood Zone ___________________________________________ Plan Sq. Ft. (A/C) ______________________________________ Plan Sq. Ft. (Under Roof) _______________________________ Finish Floor Elev. ______________________________________ DEPARTMENT APPROVALS ______________________ _______________________ Env. Services Engineering ________________________ _________________________ Planning & Zoning SPRAB / COA ________________________ ________________________ Landscaping / Irrigation Public Utilities ________________________ ________________________ Fire Department Plan Review Occ. Load _______________ COUNTY IMPACT FEES Source: ______________________________________________ (Credit) Impact Fee Amount Due Parks $__________ $___________ $__________ Public Bldgs. $__________ $___________ $_________ Schools $__________ $___________ $_________ Road $__________ $___________ $_________ PERMIT CALCULATION Adjusted Value $ ____________________________ Permit Fee $ ____________________________ Electrical $ ___________________________ Plumbing $ ___________________________ Mechanical $ ___________________________ Roofing $ ___________________________ Paving $ ___________________________ Irrigation $ ___________________________ Landscaping $ ___________________________ Shutter $ ___________________________ Misc Permit $ ___________________________ Other $ ___________________________ Plan Check Fee $ ___________________________ MCR # ______________________________________________ Total Permit Fee $ ____________________________ ADDITIONAL FEES Fire $ ____________________________ Radon $ ____________________________ DPR $ ____________________________ Water / Sewer $ ____________________________ Parks / Rec $ ____________________________ Master Plan $ ____________________________ Total Additional Fees $ ____________________________ TOTAL FEES DUE $ ________________________