10-1042-001NOTE: ALL SHEET MUST BE REVIEWED
MIAMI -DADE COUNTY BUILDING DEPARTMENT (y) c— 0 ()1(.( !
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 Rp MENT
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PROVIDE MUNICIPAL PROCESS
NUMBER
Job Address
Contr No.
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Folio
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Last ur , di i o
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Contr for me
Lot Block
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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
Vacant Land
[ j Demolish
Current use of property i1aeZ4 . !'
W
[ ] Shell Only
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Alteration Interior
[ ] Addition Attached
Des ri tion of Work
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[ ] Alteration Exterior
[ ] Addition Detached
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[ ]Relocation of Structure
[ ] Re -Roof
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[ ] Enclosure
[ j Foundation Only
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Sq. Ft.- i6 ""
[ ] Repair
. _Units oors
[ ]] Repair Due to Fire
Value of Work T ad ,1X0
[ Xl. MBLD"
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[ ] Chg. Contractor
Owner—M(7 •-
Addres cz "'a
Category V
F
[ j Re -Issue
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City Stat�(..Zi ?
[ ] MELE
[ ] Re -Stamp
[ ] MLPG
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[ j Revision
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Phone "
Last four (4) digits of
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[ ] MMEC
W
[ ] Not Applicable for
3
[ ] FIRE
Fire
0
Owner's Social Security No.
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Name C
Owne - tl G C
Address
Address 5q S60 -
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City State`�Zip'!C
City Stat;�_Zi—
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FL
Phone
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Phone �G r�
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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
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and $65 per each additional hour in addition to the review fees. Minimum charge one -hour.
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1 Date:
Request:
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2nd Request: Date:
31d Request: Date:
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l am requesting Optional Plan Review (01717) 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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111 Request: Date:
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2nd Request: Date:
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3rd Request: Date:
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123_01 - 192 3/08