14-848-006NOTE: ALL SHEET MUST BE REVIEWED
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
TIJAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE
AND /OR ENVIRONMENTAL SERVICES
�_f ) /� Q (D.�3�s
PROVIDE MUNICIPAL PROCESS
NUMBER HERE
Job Address $46 �GchSGL cU1�r V�
Contractor No. �F Z00D,9P% 3
LL
z W
Folio 09y0zS060000!
z
o
Last four (4) digits of Qualifier No.
O W
- o
0 a
M cc
Contractor Name u
Lot Block
0 LL
Qualifier Name AIZAH
I00 a
j2
Subdivision PBpg
0?
Address 6 Li
City i State F/— Zip3�f'
Metes and bounds
[ ] New Construction on
[ ] Demolish
Current use of property (F�111weye ce�
U)
Vacant Land
[ ] Shell Only
LL W
[X] Alteration Interior
[ ] Addition Attached
Description of Work ve, 5 O
w w
[ ] Alteration Exterior
[ ] Addition Detached
a. o
[ ] Relocation of Structure
[ ] Re -Roof
Sq. Ft. Units Floors
m
a.
[ ] Enclosure
[ ]Foundation Only
?
[ ] Repair
[ ] Tent
po
[ ] Repair Due to Fire
Value of Work 7100.
[ ] MBLD'
[ ] Chg. Contractor
Owner Gt G /
Address
a
Category
y
[ ] Re -Issue
w
a
[�C] MELE oil
y
[ ] Re -Stamp
y
City State _Zip
[ ] MLPG
[ ] Revision
W
Phone
W
[ ] MMEC
[ ] Not Applicable for
3
Last four (4) digits of
[ ] FIRE
¢
Fire
0
Owner's Social Security No.
N
z
Name 1149( Ul n azl&_5
Owner
Address
s
z a
Address 60 20 wesfi Alk4/eY Sfi
� W
111111
� �
City MlQl�ll State Zip 1
W
I= z
v z
City State
Y
_S
_Zip
a a
Phone �7 8� Z�%� 2�%�
a W
Phone
J 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 hour
a 5 �
and $65 per each additional hour in addition to the review fees. Minimum charge one -hour.
00.
Rj N w �
1 n Request: Date:
LLw ¢
2nd Request: Date:
cc
3rd Request: Date:
z
g
-- -
I am requesting Optional Plan f*eviev, (OPR) to e scheduled as soon-as possible at the rate of $75 for each discipline.
J -
a
Additional review fees may appy
0
111 Request: Date:
o
2nd Request: _ Date:
W3rd
Request: Date:
CL
123_01 - 192 6/13 -