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11-1067-001Ma01l01043zf NO I E- ALL SHEETS MUST BE REVIEWED MIAMI -DADE COUNTY BUILDING DEPARTMENT Herbert S. Safflr Permitting and Inspection Center 11205 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 PROCESS NUMBER HERE N ,j Job Address 71'(2 D SW tp?_ "- :0 , Contractor No. E Folio Qq q-��p �� .� 4 o o Last four (4) digits of Qualifier No. LU - ° > Lot 1 Block a < Contractor Name < p c Subdivision PBpg z o Qualifier Name o Metes and bounds T U = Address City State Zip [) New Construction on Vacant [) Demolish [ ] Shell Only Current use of property Land w (] Alteration Interior [) Addition Attached } [ ] Alteration Exterior [ ] Addition Detached Description of Work VO . o [ I Relocation of Structure Re- Roof - �- � i [ ]Enclosure [ ] Foundation Only ' G Repair Sq. Ft. Floors [ ] Repair Due to Fire rUnits Value of Work [ MBLD " ©� Cat 0 gory [ j Chg. Contractor Owner - U IQ,WI( t c [ ] MELE [ ] Re -Issue . W Address ab Sw - F [ ] MLPG (] Re -stamp �, Ciry�VL�(/l (1/�.l .LWltState W [ ] MMEC Revision r z Phone a [ ]FIRE Not Applicable for o Last four (4) digits of Fire Owner's Social Security No. y Name Ur✓-c!/YL� E- f�f NameY.��J% f ail a Z a O d Address " ✓I V a- ' w W Address S �� n/ c � 4 a Cit l_ State Zp !J ] V� Phone ?015, �lD j �j �z City Mate _�_ Zip 7j�1 Q • Phone y . J z < c 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 $65 per each addition hour in addition to the review fees. Mfirimum; cFarg NW 1 " Request: (__ "• .� u = > a r 2n° Request: i ! r ( Date: 3rd Request: Date: .�' !1 Date: I am requesting Optional Plan review fees may apply. Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional _o LU 1" Request: ` > c e 2 "d Request: Date: c 3`d Request: Date: Date: Y1FO.u..DbOlI12 �Mumn.al Pc� + Aon'rtvw•,M1„