11-1243-003NOTE: ALL SHEET M UST BE REVIEWED
t DING DEPARTMENT
MIAMI -DADE COUNTY BUIL
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
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PROVIDE MUNICIPAL PROCESS NUMBER HERE
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Contractor No.
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Job Address i� F ,
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Last four (4) digits of Qualifier No. i? a
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Contractor Name ° ` �`
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Lot Block
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Qualifier Name ' � _� . ao'`�
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Subdivision PBpg
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Address IP % ' 9'z ne y Tp J t� w
City / /P)j State /,%V Zip_ �_
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Metes and bounds
[ ] New Construction on
[ ] Demolish
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Current use of property 0e, rt!/ ��,L��-C''`�� -'"`
Vacant Land
[ ] Shell Only
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[ Alteration Interior
[ ] Alteration Exterior
[ ] Addition Attached
[ ] Addition Detached
Description of Work
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[ ] Relocation of Structure
[ ] Re- Roof
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[ ] Enclosure
[ ] Foundation Only
Sq. Ft,-_nits Floors
Repair
Value of Work % X71
[ ] Repair Due to Fire
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[ ] Chg. Contractor
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Addres
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Category
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[ ] Re -Issue
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[ ] MELE
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[ ] Re -Stamp
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City State gr
[ ] MLPG
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[ ] Revision
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Phone
Last four (4) digits of
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[ ] Not Applicable for
[ ]FIRE
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Fire
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Owner's Social Security No.
Name' J, s�`
Owner
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Address I-o `' 1
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Address
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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 st Request: Dater
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2nd Request: Date:
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Date:
3111 Request:
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1 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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review fees may apply.
Additional
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111 Request:
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2 °d Request: Date:
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31d Request: Date:
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12301-192 3/06
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