Reso 2013-2154 - Laserfiche WebLink

Home Browse Search

8. Contractor Information (If known): Name: To Be Determined License # (County /State): Address: Phone #: Fax #: E -mail: Zip Code: 9. IMPORTANT NOTICE TO APPLICANTS: The written consent of the property owner is required for all applications to be considered complete. Your application WILL NOT BE PROCESSED unless the Applicant and Owner Consent portion of the application is completed below. You have the obligation to apprise the Department of any changes to information provided in this application. Application is hereby made for a Miami -Dade County Class I permit to authorize the activities described herein. I agree to or affirm the following: • I possess the authority to authorize the proposed activities at the subject property, and • I am familiar with the information, data and plans contained in this application, and • To the best of my knowledge and belief, the information, data and plans submitted are true, complete and accurate, and • I will provide any additional information, evidence or data necessary to provide reasonable assurance that the proposed project will comply with the applicable State and County water quality standards both during construction and after the project is completed, and • I am authorizing the permit agent listed in Section 2 of this application to process the application, furnish supplemental information relating to this application and bind the applicant to all requirements of this application, and • I agree to provide access and allow entry to the project site to inspectors and authorized representatives of Miami -Dade County for the purpose of making the preliminary analyses of the site and to monitor permitted activities and adherence to all permit conditions. A. IF APPLICANT IS AN INDIVIDUAL Signature of Applicant Print Applicant's Name B. IF APPLICANT IS OTHER THAN AN INDIVIDUAL OR NATURAL PERSON (Examples: Corporation, Partnership, Trust, LLC, LLP, etc.) Date City of Sunny Isles Beach Government Florida Print Name of Applicant (Enter the complete name as registered) Type (Corp, LLC, LLP, etc.) State of Registration/incorporation Under the penalty of perjury, I certify that I have the authority to sign this application on behalf of the Applicant, to bind the Applicant, and if so required to authorize the issuance of a bond on behalf of the Applicant. (If asked, you must provide proof of such authority to the Department). ** *Please Note: If additional signatures are required, pursuant to your governing documents anarafina naraamanfe nr nfhar annlinahla anraaman4e nr In—, City Manager Title C. IF APPLICANT IS A JOINT VENTURE Each party must sign below(If more than two members, list on attached page) Print Name of Applicant (Enter the complete name as registered) Registration/Incorporation Print Name of Applicant (Enter the complete name as registered) Registration/incorporation Type (Corp, LLC, LLP, etc.) State of Type (Corp, LLC, LLP, etc.) State of Under the penalty of perjury, I certify that I have the authority to sign this application on behalf of the Applicant, to bind the Applicant, and if so required to authorize the issuance of a bond on behalf of the Applicant. (If asked, you must provide proof of such authority to the Department). ** *Please Note: If additional signatures are required, pursuant to your governing documents, operating agreements, or other applicable agreements or laws, you must attach additional signature pages. * ** Signature of Authorized Representative Print Authorized Representative's Name Title Signature of Authorized Representative Print Authorized Representative's Name Title Uate Date