12-1205-003mg -0 / saob_/
NOTE: ALL SHEET MUST BE REVIEWED
MIAMI -DADE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT
Herbert S. Saffir Permitting and Inspection Center
' 11805 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (786) 315 -2100
APPLICATION FOR MUNICIPAL PERMIT APPLICANTS
THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE
AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT
PROVIDE MUNICIPAL PROCESS
NUMBER HERE
Job Address 700 O S w 62 igVG Sudl -K 5Z5'
Contractor No.
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Last four (4) digits of Qualifier No.
Lot Block
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Contractor Name
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Subdivision PBpg
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Qualifier Name
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Address
Metes and bounds
City State _Zip
[ ] New Construction on
[ ] Demolish
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acant Land
[ ]Shell Only
Current use of property o��Ce.
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[ ] Alteration Interior
[ ] Addition Attached
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Alteration Exterior
Addition Detached
Description of Work In'�er7 dl Q l fir_
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[ ]Relocation of Structure
[ ] Re -Roof
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] Enclosure
Repair
[ ] Foundation Only
Sq. Ft. 2-2-240 2� Units
[ ]
[ ] Tent
Floors
[ j R pair Due to Fire
Value of Work d? Q /74CiGL�y D
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[ ] Chg. Contractor
Owner
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[ ] Re -Issue
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Address
City State _Zip
[ ] MELE
[ ] Re -Stamp
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[ ] MLPG
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[ ] Revision
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Phone
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[ ] MMEC
[ ] Not Applicable for
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Last four (4) digits of
[ ] FIRE
Fire
Owner's Social Security No.
Name '.5USCl/) bjO% ff'e r CIG�
010
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Owner
Address C�
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Address
city r4/Q�/ State_ /i.Zip 33��z.
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Phone 3O5 5a'7 • &2 9-2—
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City State _Zip
Phone
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l am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour
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and $65 per each additional hour in addition to the review fees. Minimum charge one -hour.
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15S Request: Date:
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2nd est: Date:
31d Request: Date:
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I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline.
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Additional review fees may apply.
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s' Request: Date:
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2nd Request: Date:
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31d Request:
Date:
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