76 Ocean Blvd RES20-0257 Door Revision
Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED. City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT #: _____________________
Revision to Issued Permit OR Corrections to Comments Date: ________________
Project Address: ____________________________________________________________________________________
Contractor/Contact Name: ____________________________________________________________________________
Contact Phone: ______________________________ Email: _________________________________________________
Description of Proposed Revision / Corrections:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
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?
No Yes (additional s.f. to be added: _____________________________)
Will proposed revision/corrections add additional increase in building value to original submittal?
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
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $50.00
RES20-0257 Address: 76 OCEAN BLVD APN: 170226 0110 $50.00
BLDG SUBSEQUENT PLAN REVIEW FEES $50.00
BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00
TOTAL FEES PAID BY RECEIPT: R14078 $50.00
Printed: Tuesday, November 10, 2020 2:23 PM
Date Paid: Tuesday, November 10, 2020
Paid By: North Florida Coastal Homes
Pay Method: CREDIT CARD 393902919
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14078