312 4th St - Revision Request J _ . ` �� CITY OF ATLANTIC BEACH
`� ' 800 Seminole Road
J z � r Atlantic Beach, Florida 32233
Telephone (904) 247 -5800
FAX (904) 247 -5845
REVISION REQUEST SHEET
Date:
/5 / & Received by:
Permit Number. Resubmitted:
Original Plans Examiner:
Project Address: Project Name: /�G re
sue- '" 111 ® —Z5 z(
Contractor: • U - A ■,,y C N5. J ontact Name:
� � z tyAzz
Contact Phone :
9O(- 2/ y. (f9i/ Con ct e -mail: /:3 6/l/ 4)
Revision / Plan Check / Permit Fee (s) Due: $ —�. : Tf � ori
Description of Proposed Revision to Existing Permit:
/ C 6 L'' i- 1 t C-17/ o, Js t o s l `
0 t r 1 ., yoos rs ,+97t r z ,tg s A/i )
Additional Increase in Building Value: $ 0 Additional S.F. 0
Site Plan Revised: N //'g Public W / U Approval:
By signing below. I (print name) en) ����
is inclusive of the prop sed changes. affirm that the above revision
ig/t/ •
// /S 6
Signature of Contractor / Agent (Contractor must sign if increase in valuation) Date •
Office Use Only
•
Date: 2 - 2-16 Approved: X
PP ! 1 Rejected: -
by ; r" l _ - ' il "
Plan Review Comments:
i JAN 1 5 2016
P- -/ . • A/ .,.,10 iii; He .
Department review required Yes
Building
Planning & Zoning
Tree Administrator
Public Works
Plans Examiner
Public Utilities 2,2 /r
Public Safety / 6 b
Fire Services Date
Created 8/20/15 Rev. 2
1 I