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NOTE: ALL SHEET MU IN B REVIEWS
MIAMI -DADE COUNTY BUILDING 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
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Job Address 1 O" J'c 5Lj Jel � I ��,
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Contractor No. LS b C -S 500
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Last four (4) digits of Qualifier No. R%7a
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Contractor Name C kD)0 ] FUC
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Lot Block
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Qualifier Name Gc.
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Subdivision PBpg
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Address 97lg70 SLv 6Cf fV z,
City M ►Ct � f State � ip .S F, 7
Metes and bounds
[ ] New Construction on
[ ] Demolish
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Current 'e, i I I
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V ant Land
[ ] Shell Only
use of property_ ,g -
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[ Alteration Interior
[ ] Alteration Exterior
[ ] Addition Attached
Addition Detached
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Description WorkL� �/IVd r
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of
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[ ] Relocation of Structure
[ ] Re -Roof r
Sq. Ft. Units Floors 1
[ ]Enclosure
[ ]Foundation Only
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[ ] Repair
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[ ] Repair Due to Fire
Value of Work
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[ ] Chg. Contractor
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Owner �� i C 1�
Address
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Category
] Re -Issue
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[ ] MELE
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[ ] Re -Stamp
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City 5cwf�, IM,IOni State Ii Zip
[ ] MLPG
[. ] Revision
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[ ] Not Applicable for
[ ] FIRE
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Fire
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Owner's Social Security No.
Name lcl �' �,o
Owner 00L/w .� -ao C
Address 1 -7 ✓cd W� #70P
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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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15t Request: Date:
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2 "' Request: " _ - _ -I Date;
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31” 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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Request: Date:
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2"1 Request: Date:
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31' Request: Date:
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3/09
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