Revision RequestCITY OF DELRRY BEREH
REVISION REQUEST
ALL REVISIONS REQUIRE A SIGNED CHANGE ORDER WITH COST EVALUATION.
Date: Permit Number: 24-219407
Address Where Work is Being Done (to include unit or bay number):
Old School Sq, #8 51 N SWINTON AVE
CONTRACTOR NAME: A-EXCELLENT SERVICE, INC Phone: ( ) 561383-3855
Contact Person: KIMBERLY Fax:
Cell Phone #:
TYPE OF REVISION (Circle All That Apply): Structural Elec Mech Plbg Eng Other
ADDED CONSTRUCTION COST FOR THIS CHANGE: $
EXPLAIN REVISION: MOUINTING DETAILS WERE NOT SUBMITTED FOR JOB AND NEED TO BE
APPROVED WITH PLAN REVIEW TO BE ON JOB SITE WITH REST OF PERMIT
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, e-fee wilf be based on the Building Permit Fees.
SIGNED:
OFFICE USE ONLY
ROUTING:
PATH DEPT. APPROVED BY/DATE:
FEES: OTHER FEES AS APPLICABLE:
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