410 Mako Dr roof revision i
t
a CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
r� Telephone(904)247-5800
FAX(904)247-5845
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: Received by: Resubmitted:
Permit N ber �1- C)(t
0 * ' ns Ex finer: Project Name: 2<<
P ject Addr ss:
q� Contrac Contact Namc:l
ill 4 Contac hone : l l� - Contact a-mail:
tvision Check/Penmit Fee(s)Due: $ sem.D _
`t Description of Proposed Revision to Existing Permit:
Additional Increase in Building Value: $_ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below. I (print name) affirm that the above revision
is inclusive of the proposed changes.
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
Office Use only
Date: 11 �� Approved: Rejected: Notified by:
Plan Review Comments. nn
Cofb QC p%CIS- �� �c�14 e_op�y Q pGly rte-.
_Department review required Yes No
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