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HomeMy WebLinkAboutREVISION FORMOFFICE USE ONLY: DATE FILED: PERMIT # 21 c � - a p'3� REVISION FEE: 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: S_0. q nj DETAILED DESCRIPTION OF PROJECT REVISIONS: - G- p w �-"` -y-pa•a��oJ` c vac -� CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: CGC1524734 BUSINESS NAME: Groza Builders,lnc. QUALIFIERS NAME: John A. Groza ADDRESS: 511 SW PSL Blvd. CITY: PSL STATE: FL PHONE (DAYTIME): 772-336-7653 OWNER/BUILDER INFORMATION: NAME:cc� ADDRESS: CITY: A— c�c_a_ STATE: PHONE (DAYTIME: --I 4S ARCHITECT/ENGINEER INFORMATION: NAME: Christopher D. Beers ADDRESS: 5109 Grand Palmetto Way CITY: North Port PHONE (DAYTIME): 941-628-0635 SLCCC: 9123109 Revised 06130/17 STATE: Fl ST. LUCIE CO CERT. #: ZIP: 34953 FAX: ZIP: 3�f 9 41 FAX: FAX: ZIP: 34291