1698 MARITIME OAK DR - REVISION STEM WALL P' P"
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® �/ 0 SE1OLE ROAD
B� 1 ATLAI�'A'��SEA ,lF�, 32233
2.Jill s)
(904)247-5800
Revision Re uest Sheet
Date: /(. / 5
Received by:
Permit Number: )5- Sfie- )94.O Resubmitted:
�rxgrnal Plans Examiner: Clearance Sheet Number: NI
Project Address: 1 (-9 Project Name: aK
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Contractor:711 6.a �_ c f_uC y�f
Contact Phone Number: Q �Ti 1�1� �—Contact Nance'Jq,_,,� S
�- 0` Contact Fax Number: �L
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Revision/Plan Check/Permit Fee(s)Due:$ C a f`'�C r7 �"b (�c
�I AC.�0►✓I
Descri I tion of Pro osed Revision to Existin. Permit:
Pending Hold:
Structural:
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Plumbing:
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Mechanical:
V II ..
Electrical: I 'I„
11C.IIIM
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Misc.:
Additional increase in Building Value:$
Clearance Sheet/Site Plan Revised: N�� —•
_ Additional Square Footage:
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By signing below,I t,,rin,namo C)1vk t S C Environmental Health A
Proposed changes. ��✓lt Approval: II
affirm that the above revision is inclusive of the
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Sign;. ire of Con tr actor/Agent(Contracto siceb rmustsi
sign it increase in valuation) D
ate
Date: 8''6•r Office Use Only
Approved:_
Rejected:
Plan Review Comments:
---_ Notified by: •
flans Examiner _._--�- -----___---._-__._._._-------_---- _ ` _-_-_— •
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CrealedOS/OS/OS,jlo -v •/ ,/
Date