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10-723-001
Vi_ 't NOTE: Xt.0"LISHEET MUSTI REVIE ED MIAMI -DADE COUNTY BUILDING DEPARTMENT Herbert S. Saffir Permitting and Inspection Center C ('Q�C� 111305 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (78 31 -2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT r^ PROVIDE MUNICIPAL PROCESS NUMBER HERE Jab Address b Contractor No. p z W , 4 Folio 69 6 25. 03/` �Ofo0 O four �-� o Last (4) digits of Qualifier No. (�`1 W U 2 Contractor Name Q ". Lot Block I Qualifier Name o Subdivision PBpg 0z Address_ Metes and bounds City State ____Zip [ ] New Construction on [ ] Demolish Current use of property. - r Vacant Land [ ] Shell Only L,. w [JC ] Alteration Interior [ ] Addition Attached O N Alteration Exterior [ ] Addition Detached Descriptio i of Wor o[ c ] Relocation of Structure [ ] Re -Roof iv IL [ ] Enclosure [ ] Foundation Only Sq. Ft. Units Floors ? [ ] Repair [ ] Repair Due to Fire Value of Work [] MBLD* [ ] Chg. Contractor Owner Address / Category �� rn [ ] Re -Issue [ ] MELE [ ] Re -Stamp z CI [ ] MLPG , f Revision �] w Phone Last four (4) digits of [ ] MMEC �, [` Not Applicable for 3 FIRE r Fire O Owner's Social Security No. Name UP w Owner Address ivo 9 z w e ww Address CC City I h�f c] Statea� Zip c © City State w Fz � z IL FL Phone 3 ► zw _Zip Phone 1 am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour J z r. .K and $65 per each d' 'o our in addition to the review fees. Minimum charge one -hour. V w � 1s1 Request: Date: Irw 2"' Request: Date: Ir 31' Request: Date: '? �f.a . - requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review f pp/y. -K g W'�' i* ,Request: Date: o 2"' Request: Date: F, ML C wh a 34 Request: Date: v 123 01 -192 3/03 F— L