Reso 2013-2154 - Laserfiche WebLink

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10. WRITTEN CONSENT OF THE PROPERTY OWNER OF THE AREA OF THE PROPOSED WORK I /We are the fee simple owner(s) of the real property located at North Bay Road between 172 "d Street and 1741h Street, Sunny Isles Beach, Miami -Dade County, Florida, otherwise identified in the public records of Miami -Dade County as Folio No. 31- 2211 - 004 -0211 and 31- 2211- 066 -0045. I am aware and familiar with the contents of this application for a Miami -Dade County Class I Permit to perform the work on or adjacent to the subject property, as described in Section 4 of this application. I possess the riparian rights to the area of the proposed work (if applicable) and hereby consent to the work identified in this Class I Permit application. A. IF THE OWNER(S) IS AN INDIVIDUAL Signature of Owner Signature of Owner Print Owner's Name Print Owner's Name B. IF THE OWNER IS OTHER THAN AN INDIVIDUAL OR NATURAL PERSON (Examples: Corporation, Partnership, Joint Venture, Trust, LLC, LLP, etc.) City of Sunny Isles Beach Print Name of Owner (Enter the complete name as registered) 18070 Collins Avenue, Sunny Isles Beach Address of Owner Government Type (Corp, LLC, LLP, etc.) Date Date Florida State of RegistrationAncorporation Under the penalty of perjury, I certify that I have the authority to sign this application on behalf of the Owner, to bind the Owner, and if so required to authorize the issuance of a bond on behalf of the Owner. (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. vnu mutt attach arlrlitinnat 6 ... fi r,.— * ** r �/�'��' C kKts -V-f ke� Z, 1?\W o City Manager of Authorized Representative Print Authorized Representative's Name Title Signature of Authorized Representative Print Authorized Representative's Name Title- Dale itle Da e Date Revised 11/16/09