Change of Plan/ Revision Cover sheet
PERMIT NUMBER
Date Change of Plan Sheet #(s)
Lot: Block: Subdivision:
NOTE: In order for the Building Department to process Plan changes promptly, the individual who submits the changes
should make a sincere effort to provide the following information accurately.
Description of Change:
Verified cost of this change $
Submit copy of change order.
1. I verify that the changes/revision have been clouded & dated by the Architect/Engineer of Record
2. I verify that this change/revision affect the following inspections, which will have to be recalled.
3. I am aware that if this submittal is not complete, the Building Department may return it without review, and takes no
responsibility for the associated delays.
I acknowledge that I have read and agree to the above statements.
Contractor: Contact Person:
Phone # Fax #
______________________________________
NOTE: Only one form required per Change of Plan. No additional form required when making revisions to a change of planthat has already been
submitted to this office and is pending approval.
Applicable
Discipline
Sheet
Affected
Discipline Approved Date Denied Date
Revision
Cost
Planning
Zoning
Landscaping
Fire
Engineering
Structural
Electric
Plumbing
Mechanical
