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■� � � <br /> �`���"�`v�a� �G��6�£`i�s <br /> PERMIT�4GEIVT 14UTFiORIZ�4TIOM FORIl/i <br /> ALL IIUFORMATION IS TO BE TYPED OR LEGIBLY PRENTED <br /> I, 5tanlev K. Maclin CGC1515769 <br /> (Contractor's Name) (Contractor's License No.) <br /> Hereby authorize The Permit Group to act as my agent(s) in picking up permits in Florida . <br /> 6Vame of Agent Driver's License IVumber <br /> Phil Reyes R200-060-76-336-0(FL) <br /> Bruce Reviere R160-060-63-382-0(FL) <br /> Brian Buttafuoco B312-060-72-310-0(FL) <br /> Catherine McCarthy M263-120-83-687-0(FL) <br /> Beatriz Vukajlovic V224-070-84-828-0(FL) <br /> This form supersedes any previously submitted letter(s)of authorization. <br /> This form must contain only the person you want to pull permits in your name. To make changes to this <br /> form,you must submit a new form. This form will delete and replace any previous authorization form and <br /> the information contained thereon. <br /> �- 1 <br /> This authorization will remain in effect until STATE OF�J�J <br /> Cancelled in writing by the undersigned couNTV oF � �� <br /> License holder. <br /> Sworn to(or affirmed)and subscribed before me this <br /> ___�1__, day of ,,��,nP. . 20/�J <br /> by c �n c1 r,(� <br /> (Printed/Typed name of license holder making statement) <br /> License H der's Signature N f�Y PUBLIC <br /> \\```��IIIIIIIU/�����' ( ' n�ture of Notary) <br /> \`�.�`�\�PNDA.�,0(j���i��� 1"V'(�la/1�Q , � ( )!�n j'1 <br /> � ��� STATE ''•�' �% (Name on notary typed print d or stamped) <br /> OF ' My commission expires: ������ <br /> = TENNESSEE = personally known�or produced identification <br /> — PJOTARY — <br /> ' O�� PUBLIC _�;�a � <br /> �'� G'�••....... •'� `� <br /> '�i�� �DS '�p� ���`� (Type of identification produced) <br /> ,, ONC �� <br /> �U��Jirl�iii�NH��� <br /> 1025 Greenwood Blvd,Suite 470�Lake Mary,FL 32746�Office 407.618.2859 <br /> Page 1 of 1 <br /> I <br />