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HomeMy WebLinkAboutREVISION FORM.pdf 2101-0637OFFICE USE ONLY: DATE FILED: REVISION FEE: PERMIT # a 1 of -- Ol_ 2'_1 RECEIPT # PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982.5652 (772) 462-1553 APPLICATION FOR BUILDING PERMIT REVISIONS PROJECT INFORMATION LOCATION/SITE ADDRESS: 15-09 N. DETAILED DESCRIPTION OF PROJECT REVISIONS: 4-, �nousz G�,w,fit CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: CGC1524734 BUSINESS NAME: Groza Builders,inc. QUALIFIERS NAME: John A. Groza ADDRESS: 511 SW PSL Blvd. CITY: PSL STATE: FL PHONE (DAYTIME): 772-336-7653 OWNER/BUILDER INFORMATION: ST. LUCIE CO CERT. #: FAX: ZIP: 34UbO NAME: ' F-V�L 0, D k� �--- ADDRESS: SLR 2 y 3 CITY: Vk Psv STATE: FL ZIP: PHONE (DAYTIME: -I I1-- 10? —139IS FAX: ARCHITECT/ENGINEER INFORMATION: NAME: Christopher D. Beers ADDRESS: 5109 Grand Palmetto Way. CITY: North Port PHONE (DAYTIME): 941-628-0635 SLCCC: 9123109 Revised 06130117 STATE: Fl FAX: ZIP: 34291