11-473-002NOTE: ALL SH E'T' UST 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 • (786) 315 -2100
APPLICATION FOR MUNICIPAL PERMIT APPLICANTS -
THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE
AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT
123_01 -192 6/10
PROVIDE MUNICIPAL PROCESS
NUMBER
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Job Address i d' �f l\ . A/
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Last four (4) digits of Qualifier No.
Lot Block
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Gontractor Name
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Subdivision pgpg
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Qualifier Name
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Metes and bounds
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Address
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City State _Zip
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[ ] New Construction on
Vacant Land
[ ] Demolish
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Current
[ ] Shell Only
use of property r)
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�] Alteration Interior
[ ]Addition Attached
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[d T Alteration Exterior
[ ] Addition Detached
Description of Work A ] (fi ~J
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[ ] Relocation of Structure
[ ] Re -Roof
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[ ] Enclosure
Repair
[ ] Foundation Only
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[ ] Tent
Ft. W Units Floors
[ ] Repair Due to Fire
Value of Work , 0
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[ ] Chg. Contractor
Owner
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[ ] Re -Issue
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Address
[ ] MELE
Re -Stamp
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[ ] MLPG
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[ ] MMEC
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Owner's Social Security No.
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Name
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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 $65 per each additional hour in addition to the review fees. Minimum
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charge one -hour.
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15t Request:
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Date:
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2 d Request: Date:
31d Request:
Date:
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l am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline.
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Additional review fees may apply.
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Request: Date:
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2nd Request: Date:
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3rd Request:
Date:
123_01 -192 6/10