1661 PARK TER E - REVISION REQUEST - SLAB 3}.-1,yr,Jl.
CITY OF ATLANTIC BEACH
SSy 800 Seminole Road
Atlantic antic Beach,Florida 32233
FILE COPY Telephone(904)247-5800
FAX(904)247-5845
•
REVISION REQUEST SHEET
Date: l/- 6___-__/_.& Received by: �G —
Permit Number: Resubmitted:
Original Plans Examiner:
Project Address:/l�(p Pro ect Name:
Contractor: �t -e.,<,, c� �
"J r Contact Name: S ;
Contact Phone : o' - o9/- X05 - —�,e u;
Contact e-mail:
Revision/Plan Check/Permit Fee (s)Due:
Descri•tion of Pro.•sed Revision to Existin' Permit:
ir-6 ,1-
Additional Increase in Building Value: $
Site Plan Revised: Additional S.F.
Public W/U Approval:
By signing below.I(print name) 'd/7 � ,� /
is inclusi of the proposed c.anges. / affirm that the above revision
Signature of Contractor/54gcrrt / —�° 7 Y
•1 ractor must sign if increase in valuation)
Date
Office Use Only
Date: 4/-.?/- 16
Approved: Rejected:
Notified by:
Plan Review Co ents: ....,..... �/�
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:� t review required Yes No ---•••..w..�...
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• arming &Zoning -- I I
Tree Administrator _ ,
-
Public Works -- Plans Examiner
Public Utilities --
Public Safety -- �'2 l G
Fire Services -
Date Created 8/20/15 Rev.2
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