2346 OCEAN FOREST DR W - REVISION ` %, LAN-1--J;
V JJJ CITY OF ATLANTIC BEACH
�' fs\ 800 Seminole Road
0
°�_ j Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5845
REVISION REQUEST SHEET
Date: 97-i? Received by: Resubmitted:
Permit Number:
Original Plans Examiner: Project Name: 2 f
Project Address: a3 9 pGEyv,Rn193T DP 0,
Contractor:43 Contact Name: Hemel ,
Contact Phone : T
oy 3 6 -3v r Contact e-mail: ,Tc.0 tz @ 41.41 , („” ,
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
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APR 272016
Additional Increase in Building Value: $ -r"--'"" Additional S. .
Site Plan Revised: Public W/U Approval:
By signing below. I(print name) edGe iNiD 1, /tj-J 2 C�€,r ,)affirm that the above revision
is inclusive of e proposed changes.
Signature of Contr ctor/Agent(Contractor must sign if increase in valuati on) Date 9-? 7-7‘
Office Use Only
Date: S 3-- /(0 Approved: X Rejected:
Notified by
Plan Review Comme ts: 1 r
a S geV S-eI ` Scq n to r�rty T y', i4'
. -nt review required Yes o
Building
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Tree Administrator
Public Works Plans Examiner
Public Utilities 5--3-/6
Public Safety
Fire Services Date
Crated 8/20/15 Rev.2
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