NOT COMPLETED REVISION FORM , I? rL�l r16 CITY OF ATLANTIC BEACH
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\'f800 Seminole Road
_ J Atlantic Beach,Florida 32233
-- Telephone(904)247-5800
FAX(904)247-5845
./:
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: 7//5//Z____ Received by: _ Resubmitted:
Permit Number:
Original Plans Examiner: Project Name:
Project Address:
Contractor: Contact Name:
Contact Phone : Contact e-mail:
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
/gGc. r7- &
.007
Additional Increase in Building Value: $ 1,0,„02,024-- Additional S.F.
Site Plan Revised: Public W/U Approval:
•
By signing below. I (print name) _ . . - dLG,I affirm that the above revision
is inclusive of the • •.•sed c . ges.
7/l3/J7
Signat ,of Contractor/Agent(Contractor must sign if increase in valuation) Date
Office Use Only
Date: Approved: Rejected: Notified by:
Plan Review Comments:
Department review required Yes No
Building
Planning &Zoning
Tree Administrator Plans Examiner
Public Works
Public Utilities
Public Safety
Fire Services Date Created 4/13/16 Rev.3