CC-10-1703Ali-4 ltd ---A-AA
BUILDING
PERMIT APPLICATION
FBC 20
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
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): adet1 PLLS0 1Teg.cc4N ckotici -1 JS Phone#: 30S -
Address: 602.. 1 �Ot 5"T ftis � T
City: ice! 4 i SblWs State:
Tenant/Lessee Name: Ci- et Lx S
Email:
wrc 6 s
JOB ADDRESS: (k) .
City: Miami Shores
Folio/Parcel #: 11- 3 Z-64, - c)ll/_ ( '( 1 D
Is the Building Historically Designated: Yes
County:
Master Permit No.
CONTRACTOR Company Name: C4 RA( C4. cot. TfA-cT /o.+6 CORP
Address: I`(S° ki1veTic 1 t
City: LL PA-2K State: FL
Qualifier Name: 1flac. Ul S .1404e i GAR. (U
State Certification or Registration #: C6 L O S S I 1 S' C
Contact Phone#: Email Address:
DESIGNER A r c h i t e c t / E n g i n e e r : ICG( ' ' -' Gfe
NO _:. Flood Zone:
Value of Work for this Permit: $ 3060 Square/Linear Footage of Work:
Type of Work: DAddress DAlte
Description of Work: 114 sThLt. 14,14
ONew
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
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SEP 2 4 2010
Permit No .(,0I Q —f l Q1j
`$is - Sbi4
Zip: 7
Phone#: cce 1- fa b Z. 717
Phone#: S �' I ° . S'32t
601® 2 -1111
Zip: 2 3 tt°3
Phone #: 4Q(' 1tf''f- S3 21
ertificate of Competency #:
Phone#: g r5 " - 7Yo - 23co
ORepair/Replace ODemolition
b Ca!uill'AEN■ T 64ii T iaJ$ STE
****4xfSt41F1G****f4+ ***
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ 16 Q , 60
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) I I A'
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 CONDmONERS, 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 to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such po/ted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature
APPROVED BY
e
t'AP . 91,1 er or'� ht - — - "
g
The foregoing instrument was acknowledged before me this 23
day of Seer .2Q_. 9, by WW fS (A CN't''
who . personally known to I - or who has produced
identification and who did take an oath.
NOTARY PUBLIC
Sign: E./ 1
Print: /g
My Commission Expires:
774 A: I o / 5 10 / /1 flans Examiner
(Revised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15109Xrev6/4/10)
Structural Review
Signature
Contractor
The foregoing instrument was acknowledged before me this_a4.raL
day of , 20 l � who isfersonally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
NOTARY PUBLICS�ATE OF FLORIDA
,.,..°.4 % Jennie Byers
Commission # DD891708
%..�...,'' Expi es: OCT. 31, 2011
BONDW THRU ATLANTIC BONDING CO., INC.
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) (4 Zoning
Clerk
03- 30 -'11 08:35 FBOM-
'CA:RRICK CONTRACTING CORPORATION
Match29; 2011 .
•.IUliami Shores Viljage
• 'Building Department
' 10050'NE2' Ave . •
:Miami Shores, FL. 331.36
Attn: Bulldirtg Dept ' '
RI~: Permit Application # CC=9 -10- 17'03 • •
• Thomas J. Citric
Quelitler
. STAVE OF FLORIDA •
. Coy.NTY OF: Patin. Beach
Not ; ubliC;State of IQ, d
Re.Tence: Ft -Mia -4024
Ptease,' acc • ,�pt this fetter. as•a request to; ncel perrrilt applicationthatwas applie�d'for• by Carrick
. : Contracting Corp• on, behalfpfClear Wreless:t 1.602 E96fh Street,'Perm �C
lt #'-940 -1703. No work
• bas been, dolie4t.the job site and.Clear Wiretess .chgsen not to continue with this project Please •
contact J®ff Lktdstrom at 661-6627:71/11f. Yqu,fiaue any . additional questions: •.: . •
Sincerely,
to (or . •affirmed) and • subscribed before me this 29t day • o€ March, 2011, by .
• 1!i 0 '1'ARY 1'itfiLtC -S7 ' {& flF.i°I.ORI.
a� a
•
' Obhi� • yer5
f' _. tre t, 281t'
T -821 P002/002 F -458
•
1450'Kinetic Road • Lake Park, Florida 33403 • (561) 844 -5322 • Fax (561) 844 -5641