812 OCEAN BLVD RES21-0158 rev form 12-28-21 Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
r 800 Seminole Rd, Atlantic Beach, FL 32233
,�. j Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: R G-SZ -CSI 3B
❑ Revision to Issued Permit OR Corrections to Comments Date: 1 . ZIE ./2.
Project Address: J ( Z C C c s 1. L U D
Contractor/Contact Name: C O lis E 2U6 L L Q
Contact Phone: 7 G, -SS(p I Email: Q -‹ I N v\E- S @ ComSER.V ELu-0_,,
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Description of Proposed Revision/I Corrections:
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I 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?
❑No ❑*Yes (additional increase in building value: $ ) (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