12-1288R-001NOTE: ALL SHEET MUST BE REVIEWED
MIAMI-DADE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT
Herbert S. Saffir Permitting and Inspection Center
11805 SW 26th Street (Coral Way) - Miami, Florida 33175-2474 0 (786) 315-2100
APPLICATION FOR MUNICIPAL PERMIT APPLICANTS
THAT REQUIRE PLAN REVIEW FROM MIAMI-DADE FIRE RESCUE
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PROVIDE MUNICIPAL PROCESS NUMBER HERE- Z 0 1,392 / /0 6 0
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Last four (4) digits of Qualifier N
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Contractor Name LW_<i &n?
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Metes and bounds
[ ] New Construction on
Demolish
Current use of property 14A f2 At rA i
Vacant Land
Shell Only
z Alteration Interior
Addition Attached
02 Alteration Exterior
Addition Detached
Description of Work AS &2 Lx�* eyVftt1' Sf
0-> Relocation of Structure
Re-Roof
Sq. Ft. Units Floors
Enclosure
Foundation Only
Repair
Repair Due to Fire
Value of Work
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Chg. Contractor
Owner
Address
LU
CL Category
MELE
Re-Issue
Re-Stamp
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city State Zip
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[ ] Not Applicable for
3-
Last four (4) digits of
FIRE
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Fire
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wrier's Social Security No.
day
Address
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z 0. Address :5 40 51* ALAJ92t ;!�212 avr �z 1P
111111
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z 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
15 �- and $65 per each additional hour in addition to the review fees. Minimum charge one-hour
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Ecoal 2�d Request: Date:
31d Request: Date:
I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the ra dis
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1st Request: te:
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2nd Request: te:
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W 31d Request: Date:
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