PW-18-1774Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PW-6-18-1' 774
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Issue Date: 716/2018
Expiration: 10/04/2018
Parcel Number
Applicant
29 NW 99 Street
Miami Shores, FL 33150-
1131010180520
Block: Lot:
QUICK EQUITY BUILDER INC
Owner Information
Address
Phone
Cell
QUICK EQUITY BUILDER INC
29 NW 99 Street
MIAMI SHORES FL 33138-
(954)605-7880
29 NW 99 Street
MIAMI SHORES FL 33138-
Contractor(s)
LLORENS CONTRACTING LLC
Phone Cell Phone
(305)450-3252 (305)450-3252
Valuation:
Total Sq Feet:
$ 500.00
180
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.00
$0.00
$0.00
$0.00
$100.00
$0.00
$0.00
$100.00
Pay Date Pay Type
Invoice # PW-6-18-68077
07/06/2018 Credit Card
Amt Paid Amt Due
$ 100.00 $ 0.00
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
,
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 thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is a curate and
at all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named cono the work stated.
Authorized Signature: Owner / Applicant / Contractor
g
nt
July 06, 2018
Date
Building Department Copy
July 06, 2018 1
RECEIVED
Miami Shores Village JUN 2 8 2018
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2nd 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#: -S
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot Z3 Block 5 Subdivision (Vag.0✓t7
Folio#; 1 I 3t01 - OSao
Address: 9. O N td 9 c S)cr e-
yY'l t am'
sh , -Pt, 33 )55
UTILITY NAME:
Qualifier/Authorized Agent:
Address:
City: State: ZIP:
Telephone: Email:
State Certification or Registration #: Certificate of C mpetency #
CONTRACTOR NAME: C'ALLfe! L
Qualifier/Authorized Agent:
Address: 73 S ,3 pa{. 1/3
City: o,C.y L. State: /7- L -
Telephonij) 4Z •3LS' Email:
State Certification or Registration #Z/S/d9 73 Certificate of Competency
ZIP: 3 3/'7�'
Requests permission to install (describe work, attach separate page if necgssary) in the adjoining right of
way: ` ► O r-2 1 �Jl Cam. p l� I �- - 1 L
Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Landscape ❑ Antenna ❑ Other:
DESIGNER: Architect/Engineer:
Address:
City: State: ' ZIP: '
Telephone: Email:
Registration #:
1.i.kr4likir A Aest i.,iit
Value,of,Work for�thi,s Permit $ =
he ir' 'r Ir.•1A 8314i4k #` i7�
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20
Bond $ (if required)
:3.;#41c A7 4 fit...#.fie
F1i,raA0 ,
Square/Lineal rTootage of Work:='4'� oj'rr t
***** Fees***
Technology Fee $ 0.80 Scanning $
Total Fee Now Due $ \OO
Oz::)
Bonding Company's Name (if applicable):
Bonding Company's Address:
City: State: ZIP:
Application is hereby made to obtain a public works permit to do the work in the right of way 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, 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 IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 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 severs (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.
Signatu
The for
met
scant or Authorized Agent Company/Utility Agent
oin:,rstrument was acknowledged bfore - The foregoing instrumerit was acknowledged before
27 day of ' 7 , 20 / ' , by me this 2- day of JC)V►e , 20 / t by
at �� ct 4 7 who
Signature
Caviller t/cv'ey-6
is personaly to me or who has produced is personally known to me or who has produced
as as
1 known �—
identification.
'lam i
Sign: - ,/
Print: c)Dc.4.7
SEAL:
i407) 396.O153
JILLIAN A TAIPALE
•_': MY COMMISSION # FF987003
EXPIRES April 27, 2020
f10rpallotarySenieccorn
APPROVED BY:
identification.
Sign:
Print:
SEAL:
J
C//l�Gk 1l
who
Aiiik"' ;; JILLIAN A TAIPALE
•'_ MY COMMISSION # FF987003
EXPIRES April 27, 2020
(417)99E''153 Fler15alloterySemee.corn
*******************************************
Public � �� c Works Director, or Designee
2017-04-15