1089 Atlantic Blvd - Revision Request t
J`' , c.: CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach, Florida 32233
v ' T,elephone (904) 247 -5800
FAX (904) 247 -5845
, • . "'oil i F' scot 6 yr
•
REVISION E QUEST SHEET
Date: / / 9 -1 Recei ved by: A Q
Permit umber: = l.l 1, d:
Original Plans Examiner: Project Name:
Project Address: • O d S I�Gcg �u� �J2.�,
� i•� N 7" lL
Contractor: /7 30i („c, Xi-3 Contact Name: .dv
Contact Phone : -ci q 3 _ I.1 d
Revision / Plan Check / Permit Fee Due: $ ontact e-mail: £ . d �� z �� u � � �
Descri 1 tion of Pro , osed Re - Vision to Existin u Permit:
J ‘ 1 -11, (L t , s t • tf i Z \/ 1 s I 0 ,
Additional Increase in Building Value: $
Site Plan Revised: Additional S.F.
W / U Approval: By signing b; ow. I (print name)
� _ 1 affirm that
is inclusiv; o.' the propose es• the above revision
/ //g/i
Signature of Contractor / Agent (Contractor must sign if increase in valuation) Date
Office Use Only
Date: Approved: Rejected:
Notified by
Plan Review Comments:
C (L-_,
•
Department review required Yes No 1
Building 3<
Planning & Zoning
Tree Administrator
Public Works Plans Examiner
Public Utilities Q Z ( 0 ( \ G
Public Safety L 1 1
Fire Services •
Date Created 8/20/15 Rev. 2
■