306 12th St REV SHEET r CITY OF ATLANTIC BEACH
�' 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
(904)247-5800
Revision Request Sheet
Date: 'L ' Received by: 9�0 Resubmitted: ,
Permit Number: _ Clearance Sheet Number:
Original Plans Examiner: Project Name:
Project Address: 2t"�
Contractor: Contact Name:
Contact Phone Number: q`�nn (p Contact Fax Number:
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
Pending Hold:
Structural:
Plumbing:
Mechanical:
Electrical:
Misc.: R ema a S oro, 3W Weia, F e-d U C -1'0y-)
(57+0 rA a b ave
Additional Increase in Building Value: $ 707 Additional Squar Footage: $x
Clearance Sheet/Site Plan Revised:
, '� Environmental Health Approval:
By signing belo I(print name)fe", V/ ► 0-1k—S affirm that the above revision is inclusive of the
prop ha
t e of Contractor/Agent(Contractor must sign if increase in valuation) Date �—
Office Use Only
Date: /'- Z-1 of Approved: Rejected: Notified by:
Plan Review Comments:
/2-2'/Y
Plans E finer Date
Created 08/05/08.j to
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