FOR OFFICE USE ONLY UNIVERSAL BUILDING PERMIT APPLICATION FORM Perm?tTVPe= Jul 2013 Edition Accepted By: Application Date: Approved for use throughout Palm Beach County and Municipalities Application #2 7Q 1 KIND of PERMIT (CHECK ONE): PROPERTY PRIMARY PERMIT TENANT: SUB-PERMIT - If Fee Value of a Sub?Permit are ADDRESS: 3445 SANTA BARBARA DR. UNIT: covered under a Primary Permit, complete boxes 1, i, 4, 5, 6 - ELLIN TON . FL .33414 only to apply. If not covered under a Primary Permit, complete the entire application to apply. PHONE: 551'352'9165 FAX: 3 5 TRADE (CHECK ONE): SISKIND STRUCTURAL ROOFING ELECTRICAL PCN: 73 41 44 21 03 _000 0020 LJ MECHANICAL 11 PLUMBING FIRE r. GAS El OTHER. LEGAL DESCRIPTION: PRIMARY PERMIT ADDRESS: 3445 SANTA BARBARA DR cn?y: WELLINGTON 5 FURTHER WORK DESCRIPTION: ADD OUTLETS FOR TEMP POWER Type of Work: :1 New Addition :1 Alteration Repair Demo Temporary Other VALUE: 500-00 PERMIT FEE: NET S.F (for (SEE FEE (AS APPLIES) OWNER BUILDER PER FL. ST. 489 (AS NAMED ABOVE, FOR CONTACT INFORMATION SEE BOX 2) CONTRACTOR (CERT. HOLDER): JAMES BEHLMER License II: 3313005059 03A (COMPANY NAME): CARDINAL ELECTRIC. INC Contact person: ROBERT TREPP ADDRESS: 235 N. JOG RD. STE: cn?y; WEST PALM BEACH STATE: FL 33413 561-753-3131 FAX: 561-795-5524 EMAIL: ?rm. CARDINALELECTRICINCCOM 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. 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. . ISIgnature of Owner or Agentl (including contractor) 5i of Owner or ent {including contractor) Print Name: Pcirit Name: JAMES BEHLMER NOTARY REQUIRED IFS 2,500 OR MORE, OR FOR ALL OWNER REQUIRED IF 5 2,500 OR MORE, OR FOR ALL OWNER I BUILDERS REGARDLESS OF VALUE STATE OF FLORIDA BUILDERS REGARDLESS OF VALUE STATEOF ORIDA COUNTY OF COUNTY OF PALM BEACH cg Sworn to (or af?rmed) and subscribed before me this Sworn to (or af?rmed] and subscribed b/efc?I/re me this 12TH day APRIL . 20/18 by JAMES Name of person making statement) (Name at pen-crumb Va Tm-x )4 If?. 4 (Signature 0? Notary Public - State 0* ?midal (Signamta ublic - State of Floridal BP18-00001476 (Print, Type, or Stamp Commissioned Name of Notary Public) (Print, Type, or St Personally Known 0R Produced Identi?cation P'Ersonally Koo/wn OR Produced Identi?catiuiinances and Type of Identification Produced - - in effect in the Village Of Wellingt Type of IdeKtI?catIon Produced . review does Commissioned Name "f ??a'il'e'il?ill??lfor compliance with: ere ntly .3 not reIIeve Applicant from full respor sibility Commission I: 112699 Expires 21 04/17/18 Bonded IhrOugh nanolary I ELLINGTON Fe a a Iic ble Igglga?gng. 0A3 THE VILLAGE OF .1. . FEE SIMPLE TITLEHOLDER, BONDING COMPANY, AND MORTGAGE LENDER INFO IS REQUIRED WHEN THE AGGREGATE VALUE (TOTAL COST OF ALL IMPROVEMENTS 8: NOT JUST WORK AUTHORIZED BY THE INDIVIDUAL PERMIT) IS $2,500 OR MORE (EXCEPT HVAC REPAIR $7500). PLEASE ADDRESS ALL ITEMS. 1.9 Fee Simple Titleholder?s Name (lfother than owner}: Bonding Company: Fee Simple Titleholder?s Address (If other than owner]: Bonding Company Address: City: State: Zip: City: State: Zip: :1 Same as Owner 3 Not Applicable 11. Architect/Engineer?s Name: Mortgage Lender?s Name: Architect/Engineer?s Name Address: Mortgage Lender?s Address: City: State: Zip: City: State: Zip: El Not Applicable :1 Not Applicable WARNING T0 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 2 CODE USE (CHECK ONE): :1 1 8: 2 FAMILY I: TOWNHOUSE I: CONDOMINIUM MULTI-FAMILY COMMERCIAL El INDUSTRIAL C1 AGRICULTURAL - BLDG CODE EXEMPT OTHER: 2 USE CHANGE: 1.5 APPROVED BY: DATE: Permit Officer AUTHORIZED FOR CERTIFICATE OF OCCUPANCY: DA c. Building Of?cial or Designee BP18-00001476 AUTHORIZED FOR CERTIFICATE OF COMPLETION: '13. Reviewed for compliance with: cod?W or Inances a ations currently in effect in the Village of Wellin ton. Building Of?cial or Designee Performance of this review does not relieve the Applicant from resp nsibility to comply with ?g?b 5% codes, ordinances and regulations. 04/17/18 WIN THE VILLAGE OF 7333. ELLINGTON