HomeMy WebLinkAboutAUTHORIZATION FORM (1)DocuSign Envelope ID: 39B37D54-OB23-4AA1-80CE-EFFE409A08BA
GROZA BUILDERS, INC.
511 SW Port St. Lucie Blvd.
Port St. Lucie, FL 34953
(772) 336-7653
CGC1524734
Date:
To Whom It May Concern:
I (We) u ck �aaookxxr- herebyauthorize Gr za • sunders, Inc.
to act as my (our) General 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:
Address: A�
Thank You,
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Signature
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State of: & — County of: � -Q--
The foregoing instrument ws acknowledged before me this clay of
20 2- . by Lloyd a,..0�1- -�4-1cl whom O is personally known to`me, •or ( )
has produced -entification, and who did not take oath.
Notary Signature: (Notary Seal)
CAM A KeNy Finley
Notary Public
State of Florida
Comm# HHOS2506
Expires 1/19/2025