2021 SELVA MADERA CT - REVISION SHEET CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
j Telephone(904)247-5800
FAX(904)247-5845
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'-�JF31c � REVISION REQUEST SHEET
Date: ( • 2 0 • 2_01 Received by: Resubmitted:
Permit Number: 1/0 - RAW- 2Z 4.
Original Plans Examiner: Project Name:
Project Address: 20ZI VA MADE/aA Cr
Contractor: • - Ll S •., 'r 111,:. a • ontact Name: PEA E,y Co fki13IF,L3(.)
Contact Phone : 24•q • 70 fp Contact e-mail: - y (� �,: . • . ]):, a 1DM
Revision/Plan Check/Permit Fee(s) Due: $ 5'O, e)6
Description of Proposed Revision to Existing Permit:
Foil 7•(�Us S - ___ 1-
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Additional Increase in Building Value: $ 0 Additional S.F._ —a--
Site Plan Revised: n(A Public W/U Approval:
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By signing below. I(print name) affirm ttit the above revision
is inclusive of the proposed changes. �/1N 2 ��
Signature of Contractor/Agent(contractor must sign if increase in valuation) Date - - _ -
/ Office Use Only
Date: /_2 Y /7 Approved: _-- Rejected:-_----_---___ Notified by:
Plan Review Co ments:
G ►tIrev Q5 .nti Ite-,
De•artment review required Ye No
Buildin• _ �V _fit
g&Zoning
Tree Administrator Plans Examiner
Public Works
Public Utilities 1 dl-/
2
Public Safety
Fire Services Date Created S/20/15 Rev.2
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