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HomeMy WebLinkAboutAPPROVED, REVISION FORMOFFICE USE ONLY: DATE FILED: REVISION FEE: LOCATION/SITE ADDRESS: PERMIT # 01 1 O B " rK 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 DETAILED DESCRIPTION OF PROJECT REVISIONS: CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: CSC 1524734 BUSINESS NAME: Groza Builders QUALIFIERS NAME: John A. Groza ADDRESS: 511 SW PH BLVD CITY: PSL PHONE (DAYTIME): 772-336-7653 STATE: FL OWNER/BUILDER INFORMATION: --,-usS doffs ST. LUCIE CO CERT. #: 16814 FAX: ZIP: 34953 NAME: 7'0 e 1-1��� CL ADDRESS: 1 \ \ S SA.�_ CITY: f S STATE: FL ZIP: PHONE (DAYTIME: �J,? c),;)3 S FAX: ARCHITECT/ENGINEER INFORMATION: NAME: Christopher Beers ADDRESS: 5109 Grand Palmetto Way CITY: Northport PHONE (DAYTIME): SLCCC: 9123109 Revised 06130/17 941-628-0635 STATE: FL FAX: ZIP: 34291