HomeMy WebLinkAboutAuthorization FormDocuSign Envelope ID: 40887DD5-9B50-40C9-A703-492530439576
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) r kaei c Alcw on , hereby authorize Groza Builders, 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: �_ Block:
-7(o
Address: 5m ACAI r'l4W 7ral
Thank You,
DocuSigned by:
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Signature
Signature
Unit: (,
State of: F► or;dla= County of:
The foregoing instrument ws acknowledged before me this
13 day of Aiu z
20 �-1 . by ��w Le t �l iv. '� , whom (4 is personally known to me, or ( )
has produced as identification, and who did not take oath.
Notary Signature: (Notary Seal)
Kelly Finley
q< Notary Public
o ,.-z -State of Florida
191�2 Comm# HH0S2506
Expires 1/19/2025