1963 COLINA CT - REV REQUEST s
�� CITY OF ATLANTIC BEACH
J `� 800 Seminole Road
` s f Atlantic Beach, Florida 32233
;-.. r� Telephone(904)247-5800
`) v FAX(904)247-5845
REVISION REQUEST SHEET
Date: 0 /S� Received by: Resubmitted:
Permit m er: / .5-- IZ 4/9/?— 6 6r
Original Plans Examiner: Pro'-c Name: /4 _
Project Addre s: 4 /» A. ,_
'
Contractor: f /.. , .,,, , LLL Contact Name:
Contact Phone : q0V, J'/ '-WyL Contact e-mail: ri c.6,arof v,,,te..s e In f_ Ct
Revision/Plan Check/Permit Fee (s) Due: $ (f
Description of Proposed Revision to Existing Permit:
ic-, Cif.", tirAt sitvx c3-1' /et,. /94/-,--■&
Additional Increase in Building Value: $ Additional S.F. //c ,/ —
Site Plan Revised: Public W/U Approval:
By signing below. I (print name) / e c. -.1 a..f' affirm that the above revision
is inclusive of the proposed changes./ 1.(/..,4..... 7/yi_C
SignaKire of Contractor gent(Contractor must sign if increase in valuation) Date
c.--
Office Use Only
Date: /0' S 7 ) Approved: N Rejected: Notified by:
Plan Review Comments:
Scra m Ito pe r m v )- - ,r J-e
-pa ment review required Yes No
anning &Zonin7ii _______Tree Administrator Pans Examiner
lc Works
Public Utilities /0 ' S '/ i
Public Safety
Fire Services Date ('rated 8/20/15 Rev 2