1089 ATLANTIC BLVD - REVISION SHEET f, ,.a�f✓ CITY OF ATLANTIC BEACH
Jy 800 Seminole Road
.,- Atlantic Beach,Florida 32233
J /;� Telephone(904)247-5800
/ FAX(904)247-5845
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REVISION REQUEST SHEET
Date: 4 o? ?// ( Received by: Resubmitted: 9/2 g/ I 1;---Permit umber: /r-Clti/k W --I 3 f,7
Original Plans Examiner: Dfty/4p • 4,1 IS a Project Name:4 j 4 , SS (-14 S fax*/C
Project Address: foe,aly.,vbi f /vd•
Contractor: p au,c,U,E 1-S Contact Name: 7-541 0,E) a.
Contact Phone : gv y) e-3 r---1/i y Contact e-mail: J p4 A.a�/t,D g tS & �
Revision/Plan ec 7 Permit Fee (s)Due: $ o. C d�
Description of Proposed Revision to Existing Permit:
,(Jc W SE,, e 4/t, ra✓b.erit./c Se -c £
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below.I(print name) affirm that the above revision
is inclusive • ' pro.•.- changes.
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Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
Office Use Only
Date: Approved: Rejected: E 0 E;r,V
Plan Review Comments: ,. P 2 9
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Department review required Yes No
Building
Planning &Zoning
Tree Administrator Plans Examiner
Public Works
Public Utilities
Public Safety
Fire Services - Date Created 8/20/15 Rev.2
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