1769 BEACH AVE ERES21-0194 rev 8-13-21 Revision Request/Correction to Comments *'ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
0110. Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 4-019 LI
I Revision to Issued Permit OR IX] Corrections to Comments Date: g//1/..?t
Project Address: /76 Y Lisa 6-4 44,e. 4144-1-; lea<�, FG- 3.2.233
Contractor/Contact Name: ,; I E/e -4-i e 'o. 0,2 0,T vi (t2
Contact Phone: (104z) 333- °[ 343 Email: H?i (� (/rli tPek . Gor.vr
Descriptionr1of Proposed Revision/Corrections:
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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?
14 No Yes (additional s.f.to be added:
• Will proposed revision/corrections add additional increase in building value to original submittal?
XNo ____]*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
H Approved L_i 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 Updated10/17/18