2337 - A SEMINOLE RD - REV FOR AN ADDITIONa
a.. CITY OF ATLANTIC BEACH
- -_ s• 800 Seminole Road
.y' 1 Atlantic Beach, Florida 32233
Telephone(904)247-5800
J / FAX (904)247-5845
REVISION REQUEST SHEET
Date: -//`" 3,15 Received by: _Sie) Resubmitted:
3
Permit Number: /S-,ef3D/.7 ' -
Original Plans Examiner: Project Name: 4",/210,-, a�aiah
Project Address: 2 37 _.,,i47/1i.?e/e /,�/� Acw.A
Contractor: y,r/t� Contact Name: �prgh ,gaA/
Contact Phone : �U�) 04 4'252- Contact e-mail:._5trslabb.,fwAt8e?o/._c. _._ _-
Revision/Plan Check/Permit Fee(s) Due: $
Description of Proposed Revision to Existing Permit:
,o tofn.J a"Vi h I ?D Syteare dee - - - -
Additional Increase in Building Value: $ SOO Additional S.F. o?O
Site Plan Revised: __ - Public W/ U Approval:__-__
By signing below. I(print name) - </ra A A /✓DA _ affirm that the above revision
is inclusive of the proposed changes.
—;<r 9/3/;5
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
Office Use Only
Date: —_---- _- Approved: _____ .- Rejected:-..-
Notified by
Plan Review Comments:
:; • • —nt review required Yes No
Planning &Zonin•
-tor Plans EMITTliner
public Utilities 9/i C/ -
. b_ -
Fire Services Date aemet teats Rev.2