14-375R-001\,41
NOTE: ALL SHEET -MUST BE REVIEWED P
IAMI -DADE COUNTY BUILDING AND NEIGHooRHOOD COMPLIANCE
Herbert S. Saffir Permitting and Inspection Center 33175-2474 - (786) 315-2100
11805 SW 26th Street (Coral Way) •Miami, Florida ERMIT APPLICANTS
APPLICATION FOR MUNICIPAL
THAT REQUIRE PLAN REVIEW FROM MIAMI- DADEI MANAGEMENT RESCUE
AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES /`
PROVIDE MUNICII•AL- PROCESS NUMBER HERE
nuwj Job Address 6200 SW 72nd ST Suite 602
Contractor No.
oo Last four (4) digits of Qualifier No._
UO 15 Folio 09 -4036 040 -0131 p ` Geicon, Inc
C ontractor Nzme
Lot Block o Qualifier Name Richard Geisland
t p OLL 2519 SE Willoughby Boulevard
p Subdivision PBpg OK Address
Metes and bounds City
Stuart State FL Zip 34994
Demolish VACANT
( ] New Construction on C ] Current use of property
en Vacant Land [ ] Shell Only
X Alteration Interior [ ] Addition Att ached INTERIOR RENOVATION
[ ] scri tion of Work
'� �' Detached Dc p
o� Alteration Exterior [ ]Addition
o[ ] Relocation of Structure ( ] Re -Roof
`
Enclosure Foundation Only Sq. Ft 350 —Units _Floors
[ ] ( ] 0
2 ( ] Repair Value of Work $250,000
[ ] Repair Due to Fire '
Ch Contractor Owner. -�
C ] MBLD' C ] 9 2 Address
j [ ) Re -Issue
Category z City �:. �tzte,,, -ipf
MELE ( ] Re -Stamp y�
C ] MLPG 'Revision Phone
le MMEC [ ] Not Applicable for Last four (4) d j
its of, j
C ] It Fire Owner's Social Security No.
[ ]FIRE
Owner BAPTIST HEALTH SOUTH FLORIDA
O Name 0u.1a 8900 NORTH KENDAL DR.
�, w � Address
o ` Address X z City MIAMI State FL Zip 33176.
c & City State Zip. .--,.— O Z
`y d< Phone
i. Phone
s possible at the rate of $1,40
I am requesting a Special Request Plan Review (SRI) to be scheduled as soon a �0 for the first hour
i 5 c and $65 per each additional hour in addition to the review fees. Minimum charge one -hour.
`y Date:
ww 1- Request:
Date:
WD 2"' Request: LU ac Date:
C 31d Request:
z
FAdditional requesting Option! Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline,
review fees may apply
o Date:
o equest:
Date:
o 2 °1 Request:
2 Ir pate:
It w 31d Request:
123-.01-192 12/09