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PW-17-2831`gHORES L�! h� o� FLORIOp' Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. PW-11-17-2831 0 e t Permit Type: Public Works ' work Classification: Public Works Permit Status: APPROVED Parcel Number Issue Date: 11/30/2017 ] Expiration: 02/28/2018 Applicant 526 NE 97 Street 1132060171530 Miami Shores, FL 33138- Block: Lot: ROBERT & ALLISON LUDICKE Owner Information ROBERT & ALLISON LUDICKE 9999 NE 13 AVE MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone SOMI-TECH CONCRETE & PAVING U (786)380-0140 nning: 1 Fees Due Amount DBPR Fee $0.00 DCA Fee $0.00 Education Surcharge $0.20 Notary Fee $5.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $109.00 Phone Cell (305)754-2903 Valuation: $ 1.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PW-11-17-65777 11/30/2017 Check #: 1773 $ 109.00 $ 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 assu a 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: �( that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonir{q. rmore, I authorize the above -named contractor to do the work stated. Authorized Building De November 30, 2017 k:Owner / Applicant / Contractor / Agent rtment Copy November 30, 2017 1 Miami Shores Village F170Public Works Department (305)795-2210 Public works forms are available from the building department, 10050 NE 2"dAve., Miami Shores, FL PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: t►.) 1-1 - � E'� 3 Name of Applicant (if utility see below): /—. �. k1�(- Owner off the following described property: Legal Description: Lot Block Subdivision Folio #; Address: UTILITY NAME: Qualifier/Authorized Agent: Address: City: State: ZIP' Telephone: Email: State Certification or Registration #: Certificate of Competency # CONTRACTOR NAME: �?� Tii (iC�•� '"EL Qualifier/Authorize¢A,gyt: /"% %�C-� -- �✓� Address: � if City: State: l ZIP: �f Telephone: Email: State Certification or Registration ©O Certificate of Competency #: Requests permission to install (describe work, attach separ a pa if necessary in the adjoining right of way: zfl �L`1/ '_ %� ]4/iZ,�j Type of Work: f Paving ❑ Utility ❑ Landscape ❑ Antenna DESIGNER: Architect/Engineer: Address: city:—, . ,.. , State: Telephone: Email: ,Registration #: Value of Work for this Permit: $ 0 ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Other: ZIP: Square/Lineal Footage of Work: *****Fees***** Permit Fee $ 100.00 Notary $ _Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ T 3 Bond $ 4S, (if required) Total Fee Now Due $ 2017 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 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. Signature Applicant or Authorized Agent The foregoing instrument was ackriowledged before me day of AlodEm2 20,by G/ �% ��.4✓�'� who is personally known to me or who has produced as identification. Signature any/Utility Agent The foregoin' instru ent as ac nowledged�efore m this ay of 20� by who is personally k�o�" n to me or who a produced as identification. NOTARY PUBLIC: � NOTA Sign: l/V Sign: Print: %N�&V(!�/ W� r �OA Print: SEAL: PUBLIC: MAHARAI K. GONZq—�— MY COMMISSION it GG Ogg6'? —':XRES: November 2, 2020 Bonded Thru Notary Public Undevriters Nivia Raquel Walton Commission # GG133145 Expires: August 9, 2021 Bonded thru Aaron Notary ########### # # ############################# APPROVED BY:Public Works Director, or Designee SEAL: 2017-04-15