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09-923-002
wH O w z 0 ¢O Oa NOTE: ALL SHEET MIDST ICE REVIEWED MIAMI -DADE COUNTY BUILDING DE TM NT Herbert S. Saffir Permitting and Ins �o j� �{'� 11805 SW 26th Street (Coral Way) • Miami, Florida 3. 7� 3 5- 1 0 /" �` APPLICATION FOR MUNICIPAL ERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT PROVIDE MUNICIPAL PROCESS NUMBER MERE q�(�/� Job Address �° % � �ry /'� a Contractor No. f!_i '!__ Folio Lot Subdivision Metes and bounds [ ] Demolish [ ] Shell Only [ ] Addition Attached [ ] Addition Detached [ ] Re -Roof [ ] Foundation Only z o a Last four (4) digits of Qualifier CL � Contractor Name/-J Cr cc Qualifier Namelor, 40 OZ Address „w City Current use of property4�6 — Description of Workr�, Sq. Ft. U��nits__. Floors Value of Work --__-r:':�6 .- [ ] New Construction on Vacant Land w ] Alteration Interior W w w [ ] Alteration Exterior o [ ) Relocation of Structure a [ ] Enclosure ( ) Repair z [ ) Repair Due to Fire [ ] Demolish [ ] Shell Only [ ] Addition Attached [ ] Addition Detached [ ] Re -Roof [ ] Foundation Only z o a Last four (4) digits of Qualifier CL � Contractor Name/-J Cr cc Qualifier Namelor, 40 OZ Address „w City Current use of property4�6 — Description of Workr�, Sq. Ft. U��nits__. Floors Value of Work --__-r:':�6 .- '0 Name ©z zz m Address NCL w City 4 0 n I Phone State Zip Owner Address City State Zip Phone Last four (4) digits of Owner's Social Security No. I Owner W w Address t: z 0Z City y� Q Phone State —Zip_ -i z I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hou, v 4 N and $65 per each additional hour in addition to the review fees. Minimum charge one -hour. W w 1 y, Request: Date: ma w 2 "a Request:i Date: cc z J CL -1 za o.�: f= ay ©w 2a a w 0 3'” Request: Date: l am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review fees may apply. 1" Request: 2 11 Request: 3 " Request: 123_01 -192 3/08 Date: Date: Date: [ ] MBLD� [ ] Chg. Contractor w Category [ ] Re -Issue w [ ] MELE [ J Re -Stamp z ¢ [ ] MLPG w [ ]Revision Fr W W w cL [ ] MMEC w [ ] Not Applicable for z [ J FIRE cc Fire O '0 Name ©z zz m Address NCL w City 4 0 n I Phone State Zip Owner Address City State Zip Phone Last four (4) digits of Owner's Social Security No. I Owner W w Address t: z 0Z City y� Q Phone State —Zip_ -i z I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hou, v 4 N and $65 per each additional hour in addition to the review fees. Minimum charge one -hour. W w 1 y, Request: Date: ma w 2 "a Request:i Date: cc z J CL -1 za o.�: f= ay ©w 2a a w 0 3'” Request: Date: l am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review fees may apply. 1" Request: 2 11 Request: 3 " Request: 123_01 -192 3/08 Date: Date: Date: