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I � , <br /> � t � <br /> .. <br />' �� .. <br /> ' ` <br /> PERMIT AGENT AUTI�ORlZATION LETTE . - ! <br /> ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED <br /> I, .,q�trn r�cho.. , , hereby <br /> (Contractor name) (Contractor license no.) <br /> , authorize the following to act as my agent(s) in obtaining permits - <br /> _ _ _ _ for �iQ l��� �Ptice, ��. I . (Company name) <br /> --:,�>_�_ ;.,;>_ __��� - = - ��-�=:�'<- - - - - - _ - - - - - <br /> � <br /> - ,�: ::g:;� ;r�-:r�: �.r >.� <br /> " - �S,£�y� ' c��-'.��"vi.Y� i :y` - 7"_':�� y�'� - -j.yL.° ��� I <br /> :�'=-=fi �;� ,��t�ame;of3A ent�����w ,-�:�:�v�;:��:- -i-•�r<<�D�i�ier=�rLrcense N�o� � <br /> ,�_..� �-��«t �.: f _ <br /> r�+ r ��e3S- �����C 3G��o <br /> 'l �'' �-� ���, ; e..�- � L. 5�� -ry�- l�o- ��(�-� _ <br /> i <br /> INITIAL YOUR CHOICE: - <br /> This authorization expires one year from date of authorization � <br /> �This authorization will remain in effect unless revoked by the undersigned <br /> m writing �- <br /> This letter must contain only the people you want to pull permits in your name. <br /> To make changes, a new letter must be submitted. This letter will delete and - <br /> replace any previous authorizations and the information contained therein. <br /> STATE OF �1-- <br />� COUNTY OF �� " <br /> ; <br /> � Slivom to/affirmed and subscribed before me_this ��� day of ���T ,20��J <br /> � �o-vv_ �, _ .r� a <br /> �fz. � 7 z o <br /> Personall known OR produced identification DL# �/ <br /> ntractor's signature ota Signature � <br /> (Nota e�l _ My commission expires: f � °� �� <br /> ,,,,4pIW4p ��r�e.ra���o��� <br /> .� ��vuoac-sar.a� <br /> - ' �h►�n.ERp{ri�;lin 4.�f8 ' <br /> Camnit�ton#FF 16�902 <br /> 'y,,��� am <br /> 8orid�dtlro�i�IiUaat NaWy Asrn. <br />