356 10TH ST - REVISION 7-13-17 i
f '�'�a�• CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
N Telephone(904)247-5800
FAX(904)247-5845
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REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date:
eceived by- Resubmitted:
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Permit Number. — 17 S F 2
Original Plans Examiner: Project Name: q
Project Address: �td� e: %
Contractor: Contact Nam
Contact Phone : t Z I Contact e-mail:
Revision/Plan heck/Permit Fee (s) Due: $ 50,00
Descr' tion of Pro osed Revision to Existing Permit:
till 4
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Additional Increase in Building Value: $ Additional S.F.
public W/U Approval:
Site Plan Revised:
S /�17P�1 /`
By signing below.I(print name)_ � affirm that the above revision-
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is inclusive of the proposed changes. '�
Signature of Contractor/Agent(Contractor must sign if increase in valuation)
Date
Office Use Only
Date:
_7'11? 7 Approved: Rejected: Notified by
Plan Review Comments: I G h v coo b C b a Os
o Gon raG
i 4 i r -e•e
ment review required Yes o
CJ
&Zoning Plans Examiner
ministratororks 7- / 97'1"7
tilitiesafety Date Created 4/13/16 Rev.3
vices