00-0115-009 ------ -- - _; n IT" 11 f'1 F'-'- - F AMMMAWS, THE CITY OF SOUTH MIAMI
PUBLIC WORKS DEPARTMENT
6130 Sunset Drivel South Miami, Florida 33143
(305) 663-6350, f� (305) 261-3791 p RMIT#
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WORK WITHIN THE PUBLIC RIGHT-OF-WAY
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ITY PEI MUT 1 '
_ AI PLICATI0N
PROJECT LOCATION:
APPLICANT: l I Cr PHONE #
ADDRESS:
STREET CITY STATE ZIP
` I HEREBY REMPEST A PERMIT FOR THE FOLLOWING (BE SPECIFIC)
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ESTIMATED PROJECT COST: $ � PROJECT DURATION:
ANTICIPATED EFFECTS ON VEHICULAR AND PEDESTRIAN TRAFFIC DURING PROJECT:
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DISCUSS MAINTENANCE OF TRAFFIC PROVISIONS (INCLUDE SKETCH IF NECESSARY):
-M SIGNING THIS APPLICATION, I UNDE TAND THAT SEPARATE CITY AND/OR COUNTY PERMITS MAY BE REQUIRED FOR THIS
PROJECT. FURTHERMORE, IL AWA THAT I AM RESPONSIBLE FOR ENSURING THAT V.-FMIEC�.4 ' PLET'ECSi IN.
ACCORDANCE WITH THE PLANS AND SPE 1FICATIONS AS STIPULATED IN THE PERMIT APPROVAL :bigmn PaY��00--
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