Plan Revision Application — John Doe, Permit C-2006035117 (2007)

BROWARD COUNTY BUILDING DEPARTMENT 11805 S.W. 3rd St., Miami, FL 33175 www.cbuildings.com est 2 2006035117 APPLICATION FOR PLAN REVISION *** USE OF THIS FORM DOES NOT RELIEVE THE APPLICANT FROM COMPLYING WITH ALL APPLICABLE LAWS, ORDINANCES, RULES AND REGULATIONS OF ANY GOVERNING AUTHORITY. *** THIS FORM IS TO BE COMPLETED BY THE APPLICANT, OR DESIGNATED AGENT. *** THIS FORM IS TO BE COMPLETED BY THE APPLICANT, OR DESIGNATED AGENT. *** THIS FORM IS TO BE COMPLETED BY THE APPLICANT, OR DESIGNATED AGENT. *** Name/Project Number: 2006035117 Job Address: 11805 SW 3rd ST Applicant Name: Live Ibanez Contractor's Number: 2006035117 Contractor's Name: Live Ibanez Contractor's Address: 11805 SW 3rd ST Contractor's Phone: 305-555-1234 Owner's Name: J. Doe Owner's Phone: 305-555-1234 Owner's Address: 11805 SW 3rd ST Owner's City: Miami Owner's State: FL Owner's Zip: 33175 Description of Revision: D. Ibanez Residential (Single Family or Duplex) [x] Commercial [ ] Building [x] Plumbing [ ] Mechanical [ ] Electrical [ ] Asbestos [ ] Demolition [ ] Flood Plain [ ] Public Works [ ] Public Works Concurrence [ ] Public Works Concurrence (For South Florida Building Districts Only) [ ] Permit Name: David A. Smith Permit Number: 2006035117 STATE OF FLORIDA, COUNTY OF MIAMI-DADE Sworn to and subscribed before me this 20th day of December, 2006 (SEA) Personally Known [ ] or Produced Identification [ ] Type of Identification Produced [ ] Notary Public Signature Print Name My Commission Expires STATE OF FLORIDA, COUNTY OF MIAMI-DADE Sworn to and subscribed before me this 20th day of December, 2006 (SEA) Personally Known [ ] or Produced Identification [ ] Type of Identification Produced [ ] Notary Public Signature Print Name My Commission Expires BROWARD COUNTY BUILDING DEPARTMENT 26