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PW-05-23-1332 Cancelled
DECEIVED MAY 2 3 2023 ^' Miami Shores Village Public Works Department BY: (305)795-2210 Public works forms are available from the building department, 10050 NE 2"d 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 WEE" Name of Applicant (if utility see below): 334 NE 102nd ST LLC Owner off the followMb erty: Legal Description: L`e k 38 Subdivision MIAMI SHORES SEC 1 AMD Folio#; 1.1-3206-013-5150 Address: 334 NE 102nd ST UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: Email: State: CONTRACTOR NAME: DECO CONCRETE INC Qualifier/Authorized Agent: Address: PC) R0X 790097 ZIP: Certificate of Competency. # City: MIAMI . State: FLORIDA zip: 33172 Telephone: 305-828-5158 Email: " tlo orresQdecoconcreteinc.com State Certification or Registration #. E1500304 Certificate of Competency #: T Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way:Ci Sidewalks Replacement Type of Work: ❑ Paving ❑ - Utility © Sidewalk ❑ Electric - ❑ Irrigation ' ❑ Landscape n Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: State: Telephone: Email: Registration #: Value of Workforthis'Permit: $1, p� .00 Square Lineal Footage of.Work: 200 ZIP: „ ** Fees *** Permit Fee $ 100.0a Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ So Company's -Name (d aPAe1 - Com s Address* �_�___� State: CRy, ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way and installations as indicated.l certify that no work or installation the ndards of all laws, dprior to the issuance regulation construction in permit and that all work will be performed to meet this jurisdiction. I understand that separate permits must be secured for and that all work APPLICANT'S AFFIDAVIT: I certify that all the ui foregoing information and specifically construction in will be done in compliance with applicable laws regulating right-of-way. MMENCEMENT MAY WARNING TO APPLICANT: YOUR FAILURE TO RECORD RIGHT-OFIWAYFIFOYOU INTEND TO OBTAIN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." ated value Notice to Applicant: As a condition to promise issuance of a public works copy oofthe notice of with an ctommencement exceeding $2,500; the applicant must promise in good faiththat a copy is subject to the and construction lien lawcertified brochure will of the recorded not ce of ormmenhcemerrt musose propertV t be pc d at the job attachment. Also, a cert copy site for the first inspection which o Ic s ect'on wi I not be approved ven (7) days after the and arelins erctit i will be charged. absence of such ted notice, the fi p Signature any ent Ap nt or horiaed Agent s a owiedgesi before The foregoi instrument was gknowledge�d7beeffore Thefo i n y o L 2a�,3 by me his day of 1� Lr 20—�by ✓� whi who now me or who has produced is personally known to meter who has produced as ~�.r . as identification. Id nt9ication. „ v r —A !r■ [' J i Sign• Print: Print: SEAL: SEAL: KARIA m. AGUILAR A Notary gubllc • State of F lorida "issian # HH 305652 S At g 2E,1026''.°Prfr- My Cmm. Expires hNational Notary Assn. 9onded throng ******** APPROVED BY: 2017-0 -15 �,S1 MARIA M. AGUILAR ° . r Notary Public - State of Florida Commission # HH 305652 ��'' My Comm. Expires Aug 28. 2026 Banded through National Notary Assn, Public Works Director, or Designee