CC-10-1193• '7r Wm —3o40,
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): Shoreview Center
Address: 9999 NE 2nd Ave # 305
City: Miami Shores Ste: FL
Tenant/Lessee Name: Clearwire
Email: jweldon @rgpartners.com
JOB ADDRESS: 9999 NE 2nd Ave
City: Miami Shores
Folio/Parcel #: 11- 3206 - 0134490
Is the Building Historically Designated: Yes
FL -3030 $e
Miami Shores Village
Building Department
CONTRACTOR: Company Name: Regency Co
Address: 4332 NW 120th Ave
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit NoU 11
Master Permit No.
County:
Miami Dade
Phone #: 305 - 756 -7747
Zip: 33314
Phone #: 954-684 -3500
NO Flood Zone:
Zip: 33134
JUN 2 J 2010
ions Phone #: 954 - 868 -4657
00
City: Coral Springs State: FL '. Zi 33065
Qualifier Name: John J Pequignot Phone #: 954-868 -4657
State Certification or Registration #: CGC1505328
Contact Phone #: 954 - 3500 Email Address: :Reid
DESIGNER: Architect/Engineer: KCI
Value of Work for this Permit: $ i o Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace Demolition
Description of Work: Install Antenna and equipment on existing rooftop
..
e of Competency #:
ners.com
Phone #: 800 572 -7496
COLOR THROUGH ROOF TILE 15 REQUIRED acknowledged by:
******** * * *** * *** * * * ** * * ** * **** ** **** ** F ees ** * *****, *, * ** *, *** * * * * * **** * *a*** ***** * * **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
kURA
Bonding Company's Name (if applicable) NA
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) NA
Mortgage Lender's Address
City State Zip
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OTCOMMENCEMENT."
Notice to Applicant: As a condition to the issuance
promise in good faith that a copy of the notice of comm
whose property is subject to attachment. Also, a certified cop
for the first inspection which occurs seven (7) days after the b
inspection will not be approved and a reinspection fee will be charged
Signature
Sign:
APPROVED BY
Print Jc.&t L P- W-e.Q ce c e J
My Commission Expires:
* * * * * * * * * * * * * * * * * * * **
Owner or gent
The foregoing instrument was acknowledged before me this 2 �.
day of , 20 , by 14 P' 4 J'J rct„_
who is perso own to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
tarr'ry'••,, JULIE P. WELDON
_ fti A MY COMMISSION # DD 6520c
t and gF
(Revised 07/1 0/0 7)(Revised 06/1 0/2009 XRev ised 3/1 5/09)(rev6/4/1 0)
Plans Examiner
Structural Review
ermit with an estimated value exceeding $2500, the applicant must
construction lien law brochure will be delivered to the person
ther orded notice of commencement must be posted at the job site
it is issued In the absence of such posted notice, the
r
Signature �r
<\
The foregoing instrument was acknowledged before me this a ge 8
day of a� ,20� �"° P b j # �,
who i ' ersonall kno o me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
trac r
Commission # DD 897452
Expires June 9 2013
•4 K' BardedTAruTV Fain insurance
800.315.7019
************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zoning
Clerk