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� <br /> f <br /> / , , <br /> / , <br /> PERMIT AGENT AUTHORIZATION LETTER <br /> ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED <br /> I ;����w. ,r►�a�, �C_13cS� 5 3 S , hereb authorize the following <br /> Y I <br /> (Contractor name) (Contract r license no�) <br /> Agent name 5���ov�. �.��/ to pull permits on my behalf. <br /> Agent name 5crru "(,cL ������ to pull permits on my behalf <br /> Agent name � ull permits on my behalf <br /> To apply and pick up permits in k�c.._ `:�-v 7_c���'������5 ��_. <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 in writing <br /> This letter must contain only the people you want to pull permits in your name. To make changes, <br /> a new letter must be submitted. This letter will delete and replace any previous authorizations and <br /> the information contained therein. <br /> r-, <br /> STATE OF o r'' � COUNTY OF "�-5 G� <br /> Sworn to/affirmed and subscribed before me this day of ,20 <br /> Personally known OR produced identification DL#�'V��` p��"�� �U��'� <br /> � <br /> Contractor's signature NotarySignature <br /> (Notary Seal) My commission expires: <br /> d@�Ml�A�l►VID WUBBARD <br /> - M���MNII�ION t��Pt99429 <br /> ���R�@n�ery 15,�019 <br /> .� - <br />