00-0477-004 Approved Disapproved Fee Due
- Q MIAMI-DADE COUNTY FIRE RESCUE
REQUEST FOR INSPECTION OR PLANS REVIEW
Fire Dept. Application # Q p3 3{ —(fin c7 9 7 Date:2,�.2 0 6
Master Application # U 0 73 2--b U 0 SYo
Plan review type (Check all applicable boxes.) Occupancy Type: (Building permit only.)
0 Arle uildg permit. (Check occupancy type.) ❑ Storage/Warehouse ❑ Health Care
�� Alarm permit. ❑ Assembly (occ. 50+) 0 Industrial
❑ Sprinkler System permit. ❑ Board & Care 0 Special Structures
❑ Fire Supression Sytem 0 Business/Office 0 Lodging
0 Water Main Ext./Fire Hydrant permit. ❑ Deten/Correction 0 Mercantile/Retail
0 Other Permit ❑ Apartments/Condo 0 Hotel/Dormitory
0 Expired permit/ Renewal. ❑ Educational 0 Tents
❑ Revision to a permit still in process.
❑ Revision to an existing permit.
reviously disapproved by Fire.
❑ Miami-Dade County ocp4anicipality: City of S167��1/
Inspection type requested (Circle all applicable types.)Final C.O.; Preliminary; T.C.O.;.Fire Alarm;
Fire Pump Test;Re-inspection;Sprinkler/Standpipe; Other
Please print all information clearly.
Process number- Permit number:
Cost of contras? 26,tJ . °0 Square footage: No. Stories _L
Project Name: E Q 1-06- > 7— J�Vy/moo ya e
Job Address: 2eOa P-6 P r1zP ,
City: ,50 //Z_J State: Zip:
Scope of worts: AI-/2r
Contact Person: /—D )9— 19 t t-C 1-4 Company Name:
Permit Relationship: — ( i.e.Applicant,Arch.;Eng.;Expeditor.Contractor.)
Contact Address:
City: /=t zip: 33 o z-y
Contact Phor►rr-��c "s���c� 7�(`� -
/ r� � Phone 2 ('S tJJ >37q -37�V FaX�(
❑ I am requesting a Special Request Inspection on the following date and time:
I understand that the rate will be $75 per hour for each inspector with a minimum of 4 hours. I
will need inspectors. Signature:
❑ I am requesting a Special Request Plans Review to be scheduled as soon as possible at the
rate of$150 for the first hour and S50 per each additional hour. Minimum 1 hour charge.
Signature:
Received by: _ Assigned to:
For information call: RAial l-I)ade County Fire Rescue 305-375-2771 0!1&o form rev. 3/7/00