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178 BEACH AVE REV REQUEST
(itioam, d ITY OF ATLANTIC BEACH liar APR 16 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 6y (904)247-,5800 Revision Re_ Quest Sheet Date: N- /G - (S ----G� Received by: Resubmitted: Permit Number: � J– W N p– (pQ 0 Original Plans Examiner: ---.--___ Clearance Sheet Number: N 1A __ Project Address. -�8 R ,� Project Name: �7B �K A� Atf� nut R15 Contractor: e-4 WAEZw Cs�S----�__-_------- Contact Phone Number: -----Contact Name:.—. )I�.RK --. T –I q Z$ Contact Fax Number: Revision/Plan Checlr/Pennit Fee(s)Due:$ Descri tion of Pro osed Revision to ExistingPermit: Pending Hold: Structural: Plumbing: _— Mechanical: Electrical: –_---- Mise: �— AdditionalIncrease in Building Value:$ SMG6udpD —. Clearance Sheer/Site Plan Revised: O k=L- Additional Square Footage: By signing below,I —�— Environmental Health Approval: Proposed changes. – flftirm that the above revision is inclusive of the SignaNreo Contra for/A ¢nt Date ��• �s g (Contnaar mustaign irincreas�Mee i�Useo,ly Date Date: y/�y/ ---�__ Approved: _ eX Rejected: -Plan Review Cm-. --- Notified by: __PILO C ty , 4 Qc•�___�r.,, — tom' --- Pbans oaoaosrosaaiio Date ��