152 3RD ST REVISION 64$ �� CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach, Florida 32233
Telephone (904) 247 -5800
_ FAX (904) 247 -5845
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REVISION REQUEST SHEET 3. 0
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Date: f f Received by:
/
Resubmitte
Permit Nu bei . / s' "'^L d.
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Original Plans Examiner: Project Name:
Project Address: 1.--(.....4, si .q a
Contractor: l�"Zp t C Cont
Contact Phone : v Name:
Contact e -mail:
Revision / Plan Check / Permit Fee (s) Due: $ / 5 09
Description of Proposed Revision to Existing Permit: 3 °`�a__
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 of the proposed changes.
Signature of Contractor / Agent (Contractor must sign if increase in valuation) Date
Office Use Only
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Date: Approved: Rejected: Notified b : *
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Plan Review Comments: I
Department review required Yes�•No
Building �J s -----c---fk Planning & Zoning
Tree Administrator Plans Examiner
Public Works
Public Utilities I 6 ` .(,
Public Safety 1 1
Fire Services Date
Created 8 /20 /15 Rev. 2