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PW-18-241 ' / Miami Shores Village JL Pwmit Type:Public Works 1oonoms.2nd Avenue wvv Work Classification:Public Works Miami Shores,rLoo1u8-uono Perinlix Pemit Status:APPROVED Phone: (305)795u204 Issue Date. 21712018 [ Expiration: 05/08/2018 � Project Address Parcel Number Applicant 165 NW 92 Street 1131010331000 M iami Shores, FL 33150- Block: Lot: SAMUEL&YAEL HYKEN Owner Information Address Phone Cell SAMUEL&YAEL HYKEN 165 NW 92 Street (973)525-6113 MIAMI SHORES FL 33150 165 NVV92 MIAMI SHORES FL33150' ' / Contractor(s) Phone Cell Phone Valuation: $ 300.00 E WI INC (954)946-2204 Total Sq Feet: 80 Scanning: 1 Available| Permit Fee $100.00 . Excavation Review Public Works Final Public Works Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF' $0.00 Invoice# PW-1-18-66282 DBPR Fee $0.00 02/07/2018 Credit Card $ 104.00 $0.00 DCA Fee $0.00 Education Surcharge $0.20 ` Scanning Fee $3.00 Technology Fee $0.80 Total: $104.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations ' - pertaining _ ' -_-- _- -----_-_'-, with— 'the plans,drawings, statements~ specifications submitted ~.the proper authorities~ Miami Shores Village.- In , accepting this it / assume responsibility all work done by either myself, my agent, owmmmo. or employes. | understand that separate pennno one required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: | certify that all the foregoing information is eonun000 and that all work will be done in compliance with on oppouamc laws regulating construction and zoning. Futhermore, February 07, 2018 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy RECEIVED Miami Shores Village JAN 3 0 1018 Public Works Department {305}795-2210 Public works'forms are available froth the building department,10050 NE 2"a Ave.,Miami Shores,FL 33138 PUBLIC WORKS PERMIT APPLICATION Permit Type.Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property Permit#:�6.- ' v3 _ Name of Appiicant,(if utility see below): -�a1i d [&�8n z '7oA dvken Owner off the following described Property: Legal Description:Lot j J!/A 1,0 block_ -'�Subdivision 8', o fo-.� E:6 Folio#; i t 3i1- lLa % Address: n S W -9 ' UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: ZIP: Telephone: Email: State Certification or Registration#: Certificate of Competency# CONTRACTOR NAME: Qualifier/Authorized Agent.• 0C e, f�aZA Address: 11 .� S`) City: Pt3Mj2At10 NY266h1State:r-'--, Z1P: . ,` 'GaL Telephone: 9 +�_ 910- Email: Vi,0flilI{n �i��' State Certification or Registration#: ' 11004 2 Certificate of Competency#: Requests permission to install(describe work,attach s pa`ste page if necessary)in t�adjoi�nfling �tof way: `t cion In l� r` �' N4 `Y Type of Work: ❑ Paving 12 Utility ❑ Sidewalk E Electric ❑ Irrigation Landscape E] Antenna ❑ other: �� - EEt7EIZ �OL DESIGNER:Architect/Engineer: Address: City: - State: ZIP: _ - Telephone: Email: Registration#: m Value of Work for this Permit: $ Square/Lineal Footage of Work: ,50.4 iri Zia Jo 8 * * Fees* * Permit Fee$ 100.00 Notary$ Training/Education$0:20 Technology Fee$0.80 Scannin $ _} Bond$ (if required) Total Fee Now Due$j _ AL Bonding Company's Name(if applicable): Bonding Company's Address: City: State: _ 2{P: Application is hereby made to obtain a public works permit to do the work in the right of way and installations as indicated;.)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,regulation construction in this jurisdiction.I understand that separate permits must be secured for. APPLICANT'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all-work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT 1N- YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-7WAY.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 public works permit with an estimated value exceeding$2,500,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 the 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 public works permit is issued.In the'- absence of such posted notice,the inspection will not be approved and a reinspection will be charged. ©weercrica� c> c Signature _-•-•� Signature licant ir Authorized Agent Compa y/Utility ent The fore ping instrument was acknowledged before The foregoing ins meet as ack owledged before; me this YLb day of ZAM J 261gP�,by me his Q ay of r 20-1a ,by L who who is ersonally know to me or who has produced i personally know to me or who has produced 1)RI VQr/-[G}f as Ricnartl VViec m a, identification. identification. ao�PRY - � �NOTARY PUBLIC STATE OF FLORIDA NOTARY P(JSLiC' NOTA y BLIC: S Cwm:k GG160721 44 cE1 Expires 1112412021 Sign: Sign; �h P;int`!I /�/�/f/I/ �� print; I c. l� M"?*AAM SEAL: EMMANUELREGtS SEAL: �� MY COMMISSION 6 GG 074766 :a EXPIRES:Ap14, 1hmN APPROVED BY: , 2 ,Public Works Director,or Designee 2017-04-15