14-946R (2)-002I �� � S
ao' NOTE: ALL SHEET MUST BE RE IEWED
MIAMI -DADE COUNTY DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES
Herbert S. Saffir Permitting and Inspection Center
11805 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (786) 315 -2000
APPLICATION FOR MUNICIPAL PERMIT APPLICANTS
THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE
AND /OR ENVIRONMENTAL SERVICES
PROVIDE MUNICIPAL PROCESS NUMBER HERE
y
pp
Job Address JF EJC_-) au WNY
Contractor No. C 15191 2)5
0 W
Folio
cc
0g
Last four (4) digits of Qualifier No. �3
°
a o
Lot Block
a a
�
Contractor Na e TOYYe Li(YIL� K rl
�
Qualifier Name �1n oa
oa
i
Subdivision PBpg
Metes and bounds
oo
V?
Address* Wb Onr GI(. 10 yc
City CM 191C9 State F1 Zip =i i (4
[ ] New Construction on
Vacant Land
[ J Demolish
[ ] Shell Only
Current use of property N1
U.
[ ]Alteration Interior
[ ]Addition Attached
escription of Work &Avi G'P fl 292n v S�
WW w
[ ] Alteration Exterior
[ ]Addition Detached
o
[ ]Relocation of Structure
[ ] Re -Roof
�IFMGV-e SI-OL &WO 200rn V71
a
[ ]Enclosure
[ ] Foundation Only
?
[ ] Repair
[ ] Tent
Sq. Ft. Units Floors
[ ] Repair Due to Fire
Value of Work
[ ] MBLD"
[ ] Chg. Contractor
Owner
CL
Category
°
F
a
[ ] Re -Issue
w
a
Address
F
[ ] MELE
(n
[ ] Re -St mp,
I E�
N
City State _Zip
[ ] MLPG
W
Phone
W
[ J MMEC
[ ] Not Applicable for
3
Last four (4) digits of
[ ✓f FIRE
¢
Fire
°
Owner's Social Security No.
\VIZ
°
Name
Owner
z a
U
Addres :S%n & � �0 O -9r
w w
Address
M Y
City ` M AaM ` State Zip
z
City State
a s
e �
w
_Zip
Phon3Z1N
P
Phone
J z
I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $209 for the first hour
^
Ua
and $71.50 per each additional hour in addition to the review fees. Minimum charge one -hour.
N
Lau w
N
151 Request: Date:
�
E ¢ ¢
2nd Request: Date:
31d Request: Date:
z
g
1 am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline.
a
Additional review fees may apply.
Z. 0
�
15t Request: Date:
o2nd
Request: Date:
W31d
Request: Date:
123_01 -192 4/14
7[30f