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<br /> PERMIT AGENT AUTHORIZATION FORM
<br /> ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED
<br /> I, Anthony Gonzalez CAC1816958
<br /> (ContractoPs Name) NOT COMPANY NAME (Contractor's License No.)
<br /> he leb authorize the followin to act as m a ent s in obtainin ermits in Cit of Ze h rhills
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<br /> y;,,� %u%-�� Name of A r ent; ,,,,; ,,,�,,�, � rtver°s,:. , ,r, .� ,::,,,..,,
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<br /> ROBERT DEESE D200-762-64-171-0
<br /> LUIS PATRACAS - P362-521-760-620-0
<br /> � DAIKEL SUAREZ
<br /> 5623-160-91-211-0 I
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<br /> This form supercedes any previously submitted let#er(s) of authorization.
<br /> This form must contain only the people 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
<br /> anc�the information contained thereon.
<br /> This authorization will remain in effect until STATE OF ��t�td0.
<br /> cancelled in writing by the undersigned 11 I
<br /> license holder. COUNTY OF I�i��SbOt�ldO�r�
<br /> Sworn to(or�rmed)and subscribed before me this
<br /> ��� ,day of_S� yYl�'� ,20 �b
<br />' bY C!��trf'�C�/1 �
<br />� (PrintedlTyped ame of Lice e older Making Statement)
<br /> L' ense Holder's Signature PU LIC � �
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<br /> \\\`„1111i1�" �a Signatur fNotary)
<br /> \�����QgP�`�`�'QU�NT�ir�� (NameofNotaryTyp , rinted,�(Stamped��
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<br /> _ `�Q�����U\SSIONF�.A/fi9� My Commission expires:
<br /> � ��Q-°�������,�•� z Personally Known_�OR Produced Identification
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<br /> '9 �•;oi �Mted lbN��tO��OQa (Type of Identification Produced) �
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