08-40-004MIAMI•DADE
❑ ALL ❑ BL G
❑ HCAP ❑ LANDSCAP
❑ ROOF ❑ SIGN
❑ PERMIT BY AFFIDAVIT CHECK
Dear Applicant:
_ 66ilding_..
Herbert S. Saffir Permitting and Inspection Center.'
11805 SW 26th Street,«
Miami, Florida 33175-247. , --
1
786-315-2100'"
miamidade.gov
RE ESI R., VIEWS
❑ DERM ., ❑ EL ❑ ENRG. FIRE'!
G ❑ MECH ❑ PLUM ❑ PWKS PWCC r_ .
❑ STRU ❑ ZNPR
❑ SHORTTERM ENT AFFIDAVIT CHECK ❑ OPTIONAL PLAN REVIEW
0 ILDG ❑ ELEC ❑MECH ❑ PLUM"0 STRU
Please complete the following information for notification on the status of your plans.
Applicant's First Name: (PRINT CLEARLY) i�lfi _�_ Last Name: (PRINT CLEARLY)-tWIQ t�
Cellular Number: ! Fjr::: / (�
Office/Home Number:
EMAIL Address,Dl1v
Comments:
NOTE: IF AN EMAIL ADDRESS WAS PROVIDED YOU WILL BE NOTIFIED VIA EMAIL AND/OR AUTOMATIC
TELEPHONE CALL CONCERNING THE STATUS OF YOUR PLANS
-FOR OFFICE USE ONLY-^�-���--�`��
TO BE COMPLETED BY BUILDING EPRESEN ATIVE OR PLANS PROCESSING TECHNICIAN:
— Application Date/1 Jerk Name:
Arrival Time.
Process No(s):
❑ Walk-Thru
❑ Drop -Off Rework ❑ Re -Issue
OR
_
❑ Residential
❑ Commercial Ian ❑ Shop Drawing _
Y
TO BE COMPLETED BY PLANS PROCESSING TECHNICIANS:
BLDG CIA ❑D ON
HCAP .❑A CIDFJN ROOF ❑A ❑D ON
DERM CIA ❑D ON
LAND ❑A CID ON SIGN ❑A ❑D ON
ELEC ❑A OD ON
MECH ❑A OD ON . STRU CIA ❑D ON
ENRG ❑A OD ❑N
PLUM ❑A ❑D LIN ZNPR ❑A ❑D ON ,
'Customer Notified By:
121 Uk-117 G/OG
Date: % - Time.- u