08-1140-002NOTE: 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 MUNICIPAL PROCE55 NUMBER
HERE
Job Address (p oM le� '% 7s
Contractor No. t7 LOOM 12W -A
Last four (4) digits of Qualifier No. 3010 9-
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Qualifier Name
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Subdivision PBpg
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Metes and bounds -
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[ ] New Construction on [ ] Demolish
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Current use of property flCi5T�t G
Vacant Land [ ] Shell Only
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]'Alteration Interior [ ] Addition Attached
[ ] Addition.Detached
Description of Work - rQ
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[ ] Alteration Exterior [ ] Re -Roof
[ ] Relocation of Structure
[ ]Foundation Only
[ ] Enclosure
Sq. Ft. hits -° ` oor
[ ] Repair
[ ] Repair Due to Fire
Value of Work
[ ] MBLD =
[ ] Chg. Contractor
Owner
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Address ® --
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Category
[ ] Re -Issue
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[ ] MELE
[ ] Re -stamp
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to
City . tate -- 77
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[ ] MLPG
[ ] MMEC
[ ] Revision
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FIRE
[ ] Not Applicable for
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Last four (4) digits of
Fire
owners Social security Na.
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Name
Name
Address
Address
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City State Zip
City State Zip
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Phone
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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 and
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g-^ $65 per each addition hour in addition to the review fees. Minimum charge one -hour.
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HW 1St Request: Date:
W2 "d Request: Date:
Ir 3'd Request: Date:
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: ^ t 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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a review fees may apply.
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1" Request: Date:
0 2nd Request: Date:
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0 3`d Request: Date:
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