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Public Works & Waste Management Department Permit Section

2525 NW 62nd Street, 5th Floor Miami, FL 33147

Phone: 305-514-6610 Fax: 305-514-6880

APPLICATION FOR PERMIT TO GENERATE AND/OR TRANSPORT WASTE TIRES

SECTION 1 – ALL APPLICANTS

1.1 _______________________________________ NAME OF BUSINESS

_______________________________________

ADDRESS WHERE BUSINESS IS LOCATED

_______________________________________ CITY,STATE, ZIP

_______________________________________

CONTACT PERSON FOR PERMIT INFORMATION

1.2 ______________________________________ NAME OF OWNER/PRESIDENT/ LOCAL MANAGING PARTNER

______________________________________

TITLE OF ABOVE

______________________________________

PREFERRED MAILING ADDRESS

______________________________________

CITY, STATE, ZIP

1.3 _______________________________________ BUSINESS PHONE #

_______________________________________ ALTERNATE PHONE #

______________________________________________________

E- MAIL ADDRESS

1.4 □ 1ST TIME APPLICANT □ PERMIIT RENEWAL

IF THIS BUSINESS WAS PREVIOUSLY PERMITTED UNDER A DIFFERENT

ACCOUNT NAME, PLEASE PROVIDE THE FOLLOWING:

NAME ON PERMIT: ______________________________________________

PREVIOUS PERMIT ACCOUNT # ___________________________________

(THE PERMIT ACCOUNT# IS NOT THE DECAL/STICKER NUMBER)

1.5 Please use the following definitions to identify whether your business is a Tire Generator, Waste Tire Hauler or Both. A Waste Tire Generator is defined as “any person that is either principally or partially engaged in the selling, trading or

otherwise transferring of new, used or waste tires, whether such transactions are for cash, barter or without consideration. Retail and wholesale tire stores and other businesses that remove used or waste tires from vehicles fall within this category.

A Waste Tire Transporter is defined as “any person transporting five or more waste tires”.

Based on the definitions above check (√) one of the following:

□ Waste Tire Transporter – Complete Sections 1, 2, 4 & 5

□ Waste Tire Generator – Complete Sections 1, 3, 4 & 5

□ Both – Complete all Sections of the Application

It is unlawful for any person to carry on or conduct business or profession in Miami-Dade County without first obtaining a Local Business Tax Receipt (LBTR) from the county in which the business resides. Please provide your Local Business Tax Receipt information below: County of Issue ____________________________ Receipt # _________________________ Expiration Date :________________

If the county of issue is outside of the State of Florida, a Miami-Dade County LBTR is required. For information on the Miami-Dade County Local Business Tax Receipt, please contact the Office of the Tax Collector, 200 NW2nd Avenue, 3rd Floor, Miami, FL 33128. Phone: 305-270-4949.

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SECTION 2 – FOR WASTE TIRE HAULERS

2.2 VEHICLE LIST – For each vehicle transporting waste tires in Miami-Dade County complete the following and submit a copy of the current vehicle registration and proof of insurance for each truck and/or trailer. Attach additional sheets if needed.

YEAR MAKE/MODEL TAG# Vehicle ID (VIN) #

2.3 LIST THE COMPLETE NAME AND ADDRESS AND PHONE NUMBER FOR EVERY LOCATION THAT YOU HAVE REMOVED WASTE TIRES FROM WITHIN THE PAST 12 MONTHS. Attach additional sheets if needed.

NAME ADDRESS CITY, STATE and ZIP PHONE #

2.4 LIST THE NAME AND COMPLETE ADDRESS OF EVERY LOCATION OR FACILITY YOU HAVE USED TO DISPOSE OF WASTE TIRES WITHIN THE PAST 12 MONTHS. Attach additional sheets if needed.

NAME ADDRESS CITY, STATE, ZIP

**2.5 PROVIDE THE TOTAL AMOUNT( IN NUMBER OR TONNAGE) OF WASTE TIRES COLLECTED FROM THE TIRE

GENERATORS LISTED IN SECTION 2.3 WITHIN THE PAST 12 MIONTHS: _______________________

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SECTION 3 – FOR WASTE TIRE GENERATORS

3.1 LIST OF TIRE GENERATOR SITES – Please list the names and complete addresses of each tire generator location that

will be operating under this permit account. Attach additional sheets if needed. NAME ADDRESS CITY, STATE, ZIP PHONE #

3.2 LIST ALL WASTE TIRE HAULERS USED TO REMOVE WASTE TIRES FROM THE LOCATIONS LISTED IN 3.1 WITHIN THE PAST 12 MONTHS. All waste tire haulers used must have a current permit with this Department. To avoid violation,

please verify the hauler’s permit account status before employing them to remove your waste tires. PWWM DEPARTMENT TIRE HAULER PERMIT # NAME ADDRESS PHONE #

**3.3 PROVIDE THE TOTAL AMOUNT OF WASTE TIRES IN NUMBER OR TONNAGE REMOVED FROM ALL OF YOUR

LOCATIONS WITHIN THE PAST 12 MONTHS: ________________

SECTION 4 – ALL APPLICANTS

4.1 Provide a check, cashier’s check or money order in the amount of the total fees due payable to Public Works and Waste Management. Most credit/debit cards are also accepted.

All checks are processed using Electronic Check Service (ECS). If you choose not to have your check converted electronically. You must notify us in writing or in person prior to or along with the remittance of the check for payment. If payment is unable to be converted, it may be processed as a Check Replacement Document drawn against your account. If payment is returned due to insufficient funds, you authorize us to make a one-time electronic fund charge of $25 or 5% (whichever is greater) from your account to collect a fee as allowed by state law.

Permit Application/Renewal Fee = $ _ 25.00___

Tire Haulers:

Vehicle Registration Fee

$25 x ______ vehicles = $ ___________

Tire Generators:

$75 x ______ locations = $ ___________

Total Amount Due $ ___________

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SECTION 5 – ALL APPLICANTS

AFFIDAVIT 5.1 As an owner, officer, or local manager of the business entity submitting this application for permit to generate tires and/or

transport waste tires in Miami-Dade County, it is understood that:

A It shall be unlawful for any person to remove, collect, or transport within Miami-Dade County five or more waste

tires without first obtaining a waste tire permit from the Public Works & Waste Management Department. B. It shall be unlawful for any business to employ or hire a waste tire hauler who fails to obtain a permit from the

Public Works & Waste Management Department and/or who fails to display a current vehicle decal as

required under Chapter 15 of the Miami-Dade County Code (Code).

C. It shall be unlawful for any person to sell, trade or otherwise transfer used or waste tires within Miami-Dade

County without first obtaining a Tire Generator permit from the Public Works & Waste Management

Department as required by the Code.

D. Each tire generator and waste tire transporter shall maintain records as required by the Code. Copies of all

records that are required under this section and all supporting documentation shall be subject to inspection by

the Director of Public Works & Waste Management (Director) or his/her designee at any time and shall

be retained for a period of at least one year.

E. It shall be unlawful for any person to store waste tires at any location for a period in excess of fifteen (15)

consecutive days. All tires stored outside must be covered so as to prevent accumulation of water. This

provision does not apply to waste or used tires stored in an enclosed structure or which are mounted and/or

inflated.

F. Any change of individuals or the corporate name on the application will be reported immediately in writing to

the Director.

G. Pre-numbered, color coded decals shall be issued to each vehicle and operating site by numerical sequence

yearly, during renewal of the permit. Operating decals are to be placed on the front window or other area of the

generator site and visible for inspection. Vehicle decals are to be placed on the front windshield of all permitted

vehicles.

H. Any misrepresentation of the application requirements may cause loss of permit to do business in Miami-Dade

County.

By: _____________________________________________________ _________________ Signature of Owner/Officer/ Local Managing Partner Date __________________________________________________________________ __________________________________ Printed Name of Owner/Manager/Local Managing Partner Title ________________________________________________________________________________________________________________ Business Name Address

Sworn to and subscribed before me this ____________ day of _____________________ , 20_______

_________________________________ _________________________ NOTARY PUBLIC, State of Florida at Large Notary Stamp

*****DO NOT WRITE BELOW (OFFICIAL USE ONLY) ******

THIS BECOMES AN OFFICIAL PERMIT WHEN COMPLETED AND SIGNED BELOW BY AN AUTHORIZED REPRESENTATIVE OF THE

PUBLIC WORKS & WASTE MANAGEMENT DEPARTMENT Permit Number _________________ Date Submitted _____________ Expiration Date: ____________________

TH Decal Range ___________________ to ____________________ Total Fee Paid $: ________________ TG Decal Range ___________________ to ____________________ Processed By ___________________ Approved by: _____________________________________________ Date Approved _________________ (Authorized Representative)

VIOLATION STATUS

UCVN# ___________ Issued ___________ Status ____________ _____________________