2009 SELVA MADERA CT RES21-0332 revision 11-1-21 Revision Request/Correction to Comments **ALL INFORMATION
q%` HIGHLIGHTED IN
;, City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233 C,
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: RE_S Z - o33Z
❑ Revision to Issued Permit OR FO Corrections to Comments Date: Hi i Zi
Project Address: Z'? '/ CUL VA /WI PCM CT-
Contractor/Contact
--TContractor/Contact Name: AtEA, c1tivair)I
Contact Phone: 77C' S 7 " S Z 7 Email: SltwiLLri}6U / 1(_ _ C od '—
Description of Proposed Revision/Corrections:
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affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
No ❑ Yes (additional s.f.to be added:
• Will proposed revision/corrections add additional increase in building value to original submittal?
1RINo ❑*Yes (additional increase in building val :$ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18