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NOTE: ALL SHEETS MUST BE REVIEWED - Miami …

NOTE: ALL SHEETS must BE REVIEWEDDEPARTMENT OF REGULATORY AND economic RESOURCES Herbert S. Saffir Permitting and Inspection Center11805 SW 26th Street (Coral Way), Miami , Florida 33175-2474 (786) 315-2000 PERMIT APPLICATIONLOCATION OFIMPROVEMENTSCONTRACTORINFORMATIONOWNER S NAMECHANGE TO AN EXISTING PERMITARCHITECTENGINEERMORTGAGELENDERTYP E OFIMPROVEMENTSPERMIT TYPEPERSON TOPICK UP PLANSBONDINGJob Address _____Folio _____Lot _____ Block_____Subdivision _____PBpg_____Metes and bounds _____Contractor No. _____Last four (4) digits of Qualifier No. _____Contractor Name _____Qualifier Name _____Address_____City_____State_____ Zip _____Current use of property _____Description of Work _____Sq. Units _____Floors_____Value of Work _____Owner_____Address_____City_____Stat e_____ Zip _____Phone _____Last four (4) digits of Owner's Social Security _____Address_____City_____State_____ Zip _____Phone _____Name _____Address_____City_____State_____ Zip _____Phone _____Name _____Address_____City_____State_____ Zip _____Phone _____Name _____Address_____City_____State_____ Zip _____Phone _____*See reverse side for Building CategoryApplication is hereby made to obtain a permit to do work and installation as indicated.

NOTE: ALL SHEETS MUST BE REVIEWED DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way), • Miami, Florida 33175-2474 • (786) 315-2000

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