1628 Beach Ave Revision Submittal Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
0 Revision to Issued Permit OR Corrections to Comments Date: 2/2.2.2
Project Address: Rat aCK AvE 32233
Contractor/Contact Name: Wik. PS -Jl IDES$
Contact Phone: 904-1 - Zgte - /So0 Email: Pi-li((ii:'5uilDER5€O4",cA.ST
Description of Proposed Revision/Corrections:
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t1lMPS affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
XW' I proposed revision/corrections add additional square footage to original submittal?
No n Yes (additional s.f.to be added: )
• A i I proposed revision/corrections add additional increase in building value to original submittal?
PA o 1::]*Yes (additional increase in building y_ando• c ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: I fiLya--12----1
cECEIVE
�i FEB 0 3 2022
BY:
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