ELC-10-1194• FL -3030 EC
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: EUrt, C10 Cr
OWNER: Name (Fee Simple Titleholder): Shoreview Center
Address: 9999 NE 2nd Ave # 305
City: Miami Shores
Tenant/Lessee Name: Clearwire
Email:
jweldon@rgpartners.com
JOB ADDRESS: 9999 NE 2nd Ave
City: Miami Shores
Folio/Parcel #: 11- 3206 - 0134490
DESIGNER: Architect/Engineer: KCI.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
State: FL
CONTRACTOR: Company Name: J. Crompton Electric Inc
Address: 1799 7th Ave N
Cit Lake Worth
State: FL
Permit No.
Master Permit No.
Qualifier Name: Jonathan Crompton
State Certification or Registration #: EC13002872
dontact ?hohe# ` 95416134'3500 ° ' Email Address: jweldon@rgpartners.com
Phone#: 305-756-7747
Zip: 33314
Phone #: 954-684 -3500
Phone #: 561 - 588 -6559
Zip: 33461
Phone #: 561 - 588 -6559
Certificate of Competency #:
Phone #: 800 572 -7496
JUN 2 '6,2010
Is the Building Historically Designated: Yes NO Flood Zone:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address - ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work; Install A ntenna ` and equipment on existing rooftop
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
* ** sir*** * * * * * * * * ** ** * * * **** *,►*** *** * ** **F * **** * *+ tic***** * * * ** * * * * * * *** * *** * * * * * * **
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 $
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
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 OF COMMENCEMENT."
Notice to Applicant: As a condition
promise in good faith that a copy of the no
whose property is subject to attachment. Also, a
for the first inspection which occurs seven (7) days "affel the
inspection will nit be approved and a reinspection fee will be'eF �r
Signature
Owner ottg
The foregoing instrument was acknowledged before me this C.,.
day of , 20 Lo , by (43 Gt L Ne S rte___ ,
o me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
P. c9 c..
JULIE P. WELDON
:,r MY COMMISSION # DD 652091
<` EXPIRES: March 23, 2011
Bonded Thru Notary Public Undenvntsrs
Print:
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15/09)(rev6/4/10)
State Zip
f a building permit with an estimated value exceeding $2500, the applicant must
cement and construction lien law brochure will be delivered to the person
the recorded notice of commencement must be posted at the job site
'Wing permit is issued In the absence of such posted notice, the
Signatur
ctor
Th regoing instrument was acknowledged before me this
yof Tune , 2010,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Com
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Plans Examiner Zoning
Structural Review Clerk