HomeMy WebLinkAboutAUTHORIZATION FORM-#1304-Santana-Autryvuvuoiyn cn vcwNe iv. I000IJLv
GROZA BUILDERS, INC.
511 SW Port St. Lucie Blvd.
Port St. Lucie, FL 34953
(772) 336-7653 ph — (772) 336-2272 fax
CGCO23870
Date:
To Whom It May Concern:
I (We) p,►AA-r4 m d. Scra leu LCITL—I-hereby authorize Groza Builders,
Inc. to act as m (our) deneral Contractor/Agent for the Health, Utilities, Planning &
Zoning, Building and any other departments as required to obtain permits for the
construction of a new residential home located at:
Lot: � U Block: Unit:
Address: 'T 6b S • Gr ocKsr►m I 4-k k k
Thank You,
DocuSigned by::
µ
Signature
5 DocuSigned by:
Signed
�atn. Sa�4mA
Signature
State of: RCX-16t�--- County of: l - LGL c-A.e—
The foregoing instrument ws acknowledged before me this 1i -c; day of \�
20 2 "T1 . by I°�i � I �, k, i� Gln, r &� ,— - , �,,,� , , whom (,.)-i�"personally known to me, or ( )
has produced as identification, and who did not take oath.
Notary Signature: J 71st (Notary Seal)
t"!; , ANGIE FINLEY
;.; MY COMMISSION # GG 356163
`•`;, o`, EXPIRES: November 17, 2023
'FOf Fli�e''� Boded Rxu Notary Public Underwriters