14-1041-002{4 �
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NOTE; ALL SHEETS MUST BE REVIEWED
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 DEPARTMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT
PROVIDE MUMCIPAL PROCESS NUMBER HERE
Job Address & (2 5'-w Wt t 6 S�
Contractor No. G 1 Z
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Contractor Name�LOIZI,
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Qualifier Name C67-L4. , EAU c{f R
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Subdivision PBpg
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Address 740 Se LO- Sol 7 12
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City {fvl IAN [ State r-t- Zip 33� g3
[ ] New Construction on [ ] Demolish
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Current use of property �A GIB -2'
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Alteration Interior I ] Addition Attached
Description of Work I N�f(7SLl. izpIDt d
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[ ] Alteration Exterior [ ] Addition Detached
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[ ] Relocation of Structure
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[ ] re Foundation Only
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[ ]Repair
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[ ] Repair Due to Fire
Value of Work '34 Jj
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[ ] Re -Issue
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MELE -04,
[ ] Re -stamp
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[ ] MLPG
[ ] MMEC
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[ ] FIRE
[ ] Not Applicable for
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! am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the rrst hour and
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$65 per each addition hour in addition to the review fees. Minimum charge one -hour.
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1" Request: Date:
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2n Request: Date:
3 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. Additional
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review fees may apply.
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1s` Request: Date:
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2"d Request: Date:
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3t° Request: Date:
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