Application for Plan Revision — J & J Comfort, LLC, Permit 16-2130-SCC-001 (2014)

MIAMI-DADE COUNTY BUILDING CODE DEPARTMENT 11800 S.W. 26th, Miami, FL 33175-2401 www.miamidade.gov/building lot 4 300605119 State 00333333 APPLICATION FOR PLAN REVSION ** THIS IS FOR BUILDING, PLUMBING, FIRE PROTECTION, OR MECHANICAL PERMITS *** ** PLEASE FILL OUT COMPLETELY *** ** THIS IS NOT A BUILDING PERMIT APPLICATION *** ** THIS IS NOT A BUILDING PERMIT APPLICATION *** ** THIS IS NOT A BUILDING PERMIT APPLICATION *** Name, Firm, Agency or Organization: SANDY CREEK VILLAGE Contact Name: Lina Ibarra Contact Phone: 305-821-1677 Address: 11800 SW 26th St City: Miami State: FL Zip: 33175 Qualifying Number: [Redacted] License Number: [Redacted] Owner's Name: SANDY CREEK VILLAGE Owner's Address: 11800 SW 26th St Owner's City: Miami Owner's State: FL Owner's Zip: 33175 Owner's Name: JIM H. SCHMIDT, LLC Description of Work: SANDY CREEK VILLAGE Residential (Single Family or Duplex) [x] Commercial [ ] Applicant certifies he/she is ready for plan submittal as indicated below. I certify that all information is accurate. I understand that plans will be reviewed by the Building Code Department for compliance with the Florida Building Code, 7th Edition, and other applicable codes and regulations. I understand that the Building Code Department reserves the right to require additional information or revisions as necessary. The plan review does not relieve the applicant from the responsibility of providing a complete and accurate set of plans. The plan review does not relieve the applicant from the responsibility of providing a complete and accurate set of plans. The plan review does not relieve the applicant from the responsibility of providing a complete and accurate set of plans. This is a revision to a building, plumbing, fire protection, or mechanical permit. The permit number is: [Blank] This is a new permit. ** Please be sure to check the "New" instead of "R" for revisions if applicable ** [ ] Interbuilding [ ] Temporary [ ] Demolition [x] New Construction [ ] Addition [ ] Alteration [ ] Relocation [ ] Repair [ ] Maintenance [ ] Sign [ ] Swimming Pool/Spa [ ] Swimming Pool Enclosure [ ] Swimming Pool Fence [ ] Swimming Pool Barrier [ ] Swimming Pool Pump [ ] Swimming Pool Filter [ ] Swimming Pool Heater [ ] Swimming Pool Motor [ ] Swimming Pool Light [ ] Swimming Pool Other Signature: Lina Ibarra Date: 11-18-08 Print Name: Lina Ibarra Title: Agent STATE OF FLORIDA, COUNTY OF MIAMI-DADE Before me, the undersigned authority, personally appeared Lina Ibarra, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity, and that by her signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument. Date: November 18, 08 (SEAL) Personally Known [x] OR [ ] Produces Identification [ ] Type of Identification Produced Notary Public - State of Florida My Commission Expires: 11-18-08 Signature: Lina Ibarra Date: 11-18-08 Print Name: Lina Ibarra Title: Agent STATE OF FLORIDA, COUNTY OF MIAMI-DADE Before me, the undersigned authority, personally appeared Lina Ibarra, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity, and that by her signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument. Date: November 18, 08 (SEAL) Personally Known [x] OR [ ] Produces Identification [ ] Type of Identification Produced Notary Public - State of Florida My Commission Expires: 11-18-08 26