1703 PARK TERRACE - REVISION SHEET •
r, ���''• CITY OF ATLANTIC BEACH
800 Seminole Road
" -" - J Atlantic Beach,Florida 32233
I) l„r Telephone(904)247-5800
FAX(904)247-5845
• REVISION REQUEST SHEET
Date: k +2't/I to Received by: Resubmitted:
Permit Number: i c f-k[)P 214 1 (,
Original Plans Examiner: A i 6 o y t5 Project Name: (tro J e4,1--
Project Address: I il 0 3 ?4,K. T'e.rr Lc,. 5.
Contractor: at.",1-tl v% c 1,, s v, to A, • Contact Name: G., . 1.0_1 v Q,...I,,,try,
Contact Phone : 98(4,- S S.-16 19 Contact e-mail: lam; At) \ &)So- -t-. n.2.1--
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
ued e l , Su✓kt,. Q r e Gkk . ti G ii:a• L 4.4 C ov 1 -
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below.I(print name) `W t(L `
vvbv\v izAzr-- affirm that the above revision
is inc sive of the proposed changes.
1/ Z1/1
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
/ Office Use Only
Date: V ,// G Approved: x Rejected: Notified b
jj by:
Plan Review Comments: ' E c E Q V IR
i/t/ ► • a S&., •IThe / d - ill)!
Al . +0 s • . C -� 1111 1l1� --_ -
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Department review required Yes o
Building
Planning &Zoning
Tree Administrator V
Public Works Plans Examiner
Public Utilities _ ai 3//C
Public Safety
Fire Services Date
Created 8/20/15 Rev.2