190 CLUB DR - ACC20-0033 REV SHEET �. �-- Revision Request/Correction to Comments **ALL INFORMATION
r jHIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: Ace C 3$
®Revision to Issued Permit OR Corrections to Comments Date: 6,
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Project Address: t � C aii) 10 b I~
Contractor/Contact Name: Vv re_ ,r\c\ LQ(`d SC'_QQ e_S C 5 r\
Contact Phone: .LJ- Z-4- - 4 t J ` Email:
Description of Proposed Revision/Corrections:
Roi, v-p ( r hnccsinpicAVe (�R
I affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
Elio Sig Yes (additional s.f.to be added: )
proposed revision/corrections add additional increase in building value to original submittal?
12• 1(
No "Yes (additional increase in building value: $ )(Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18