2021 Selva Madera Ct window revision CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
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Telephone(904)247-5800
FAX(904)247-5945
REVISION REQUEST SHEET
Date:rz-/q- Received by: Resubmitted:
Permit Number: 17- K / DD - 30( S
Original Plans Examiner: Project Name:
Project Address: Z O Z. Gd era_
Contractor: els r.vlov2 pa Contact Name: 'autia
Contact Phone : 90`�e2U 2-93 S 2 Contact a-mail: !7 c C : �11 U
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existin¢Permit:
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Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W l U Approval: -By signing below.I(prmr oma) affirm that the above revision
is inclusive of the proposed changes.
Signature of Contractor!Agent(caNroi«maa sign if isaremr in vsimtm) Date
(� ^7 oaia Use Qily
DnpRelated: Noified by:
Plan vie Comments: II /
/UVC 03 $bl My'rry/s, SCQ
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rtm nt review regaired Yes No
Pa-Wing&Zoning
Tree Administrator Plans Examiner
Public Works
Public Utilities Z'/�/• /7
Public Safety
Fire Services Date a.warsma w..x