1500 MAYPORT RD CIV21-0004 REVISION SHEET 4-1-22 r 4�s �,ir, Revision Request/Correction to Comments **ALL INFORMATION
gHIGHLIGHTED IN
r ` '1 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#:C l\f 2 ( -000 4
❑ Revision to Issued Permit OR � o�rrections to Comments Date:`{ l /2-
` `C' CDC)CDC) ( '-4--- R.,J.-
Project Address: I VY 4� pol_
Contractor/Contact Name: f" .. b I v S v'tc ' i
Contact Phone: C:=.6 S-6460 - 913 Email: 90 h n A\ i\f\se-cV iCeS , C on—
K 10
Description of Proposed Revision/Corrections:
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