Revision Request (5)
REVISION REQUEST
ALL REVISIONS REQUIRE A SIGNED CHANGE ORDER WITH COST EVALUATION.
Date: ____________________ Permit Number: ________________________
Address Where Work is Being Done (to include unit or bay number):
___________________________________________________________________________________________________________
CONTRACTOR NAME: _____________________________________ Phone: ( ) _________________
Contact Person: _________________________________________ Fax: ( ) _________________
Cell Phone #: ( ) _________________
TYPE OF REVISION (Circle All That Apply): Structural Elec Mech Plbg Eng Other __________________
ADDED CONSTRUCTION COST FOR THIS CHANGE: $____________
EXPLAIN REVISION: _________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
NOTE: To avoid delay, the revision needs to be clear on the (2) drawings submitted. The Plan
Reviewers may need the job site plans.
I understand a fee may be charged in accordance with the City of Delray Beach LDR 2.4-21. The fee for a revision
is $75.00 per discipline for the first sheet, and $1.00 for each additional revised sheet.
For ADDED CONSTRUCTION COST, the fee will be based on the Building Permit Fees.
SIGNED: ________________________________________________
___________________________________________________________________________________________________________
OFFICE USE ONLY
ROUTING: FEES: OTHER FEES AS APPLICABLE:
PATH DEPT. APPROVED BY/DATE: REVISION FEE: Parks: $____________________
___________________________________ $____________________ Public Bldgs. $_______________
___________________________________ Schools $___________________
___________________________________ ADDED VALUE PERMIT FEE: Road $_____________________
___________________________________ $____________________ Radon $____________________
___________________________________ DPR $______________________
CHANGE ORDER DOCUMENTATION ACCEPTED: Other $_____________________
______________________________
PLAN REVIEWER:___________________
DATE:_____________________________ TOTAL FEES DUE: $_________________________
Rvsd 8/15
5/22/24 23-208993
22 W ATLANTIC AVE, DELRAY BEACH FL
SOUTHERN INTEGRATED SYSTEMS
MIKE D'ANGELO
941 780 9684
FIRE ALARM
2500
Capturing fire alarm changes to the Retail & Restaurant
that were requested from the GC and owner