2221 LAUGHING GULL - REVISION POOL 1A-IV
-- CITY OF ATLANTIC BEACH
800 Seminole Road
A - j Atlantic Beach,Florida 32233
J J " Telephone(904)247-5800
FAX(904)247-5845
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REVISION REQUEST SHEET
Date: 3( t 4 c t 6 Received by:
Permit Number: I 5 POOL - Resubmitted:
(�o Z 61 T
Original Plans Examiner: 1j j-4c— Project Name: P o cv L
Project Address:2.Z.2l L 160-IGtk∎.4 6- 4-1"
Contractor:joA4 [,1V12-,KZ,-R. Contact Name:
Contact Phone : 14 3- 2 D(, 0 Contact e-mail:
Revision/Plan Check/Permit Fee(s)Due: $ 5-0. p V
Description of Proposed Revision to Existing Permit:
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Additional Increase in Building Value: $
Site Plan Revised: Public ` "Tire- `.„ T._ro_a—
By signing below.I(print name)
is inclusive of the proposed changes. «'�'"; �c.
f r (1.441-1) (f ' .‘
Signature of Contractor/Agent(Contractor must sign if increase in valuation)
Office Use Only / O.e`er Te-
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Date: Approved: Rejected: /
Plan Review Comments:
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Department review required Yes
Building -‘ 11%Planning &Zoning
Tree Administrator
Public Works Plans Examiner
Public Utilities
Public Safety '3 it 4 ( �
Fire Services
Date Created 8/20/I5 Rev.2
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