71 19TH ST - REVISION 7/21/17 (.1-1,jvi..,,�� CITY OF ATLANTIC BEACH
Okt.,:: ` 800 Seminole Road
..., s,, Atlantic Beach, Florida 32233
A ° j Telephone(904)247-5800
j r.— FAX(904)247-5845
'�!J;31c•P REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: 7 0 /''7 Received by: Resubmitted: C,RG S 17-o 05`7
Permit umber:
Original Plans Examiner: Project Name:
Project Address: '7/ /.1 /4 5.1"
Contractor:OCCIM El!T Contact Name: .7/.4 /
Contact Phone : 07 y ——,j'//a Contact e-mail: 4 Ce q,,/r/C Ca her/510 c' i./,e,
Revision/Plan Check/Permit Fee (s) Due: $
Description of Proposed Revision to Existing Permit: -A.DD IS / /
r1
c• 3 Cw i the S'
4 8 Receppictes
17
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below. (print name) 4/ Ci44,% !leve'g/l/ affirm that the above revision
is inclusive of '1' •••sed changes.
AO _ee,( j,e,e„et7A///9
Signature of Contractor/Agent (contractor must sign if increase in valuation) Date
Office Use Only
Date: Approved: Rejected: N/A to Dept:
0 1 7
Plan Review Comments: l / 1 �'
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Department review required Yes No
Building — -
Planning &Zoning Plans Examiner
Tree Administrator
Public Works
Public Utilities
Public Safety Date created ci X3'17 Re. 4
Fire Services