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<br /> � � � PER.MIT �AG�ENT- AUTHORIZATIO:N FORM � ; _ , , �� :� �
<br /> ALL�INFORMATION IS-TO."BE TYPED:OR LEGIBLY PRINTED '
<br /> I Anthon Gonzalez CAC1816958
<br /> (Contractor's Name) NOT COMPANY NAME (Contractor's License No.)
<br /> her b authorize the followin to act as m a ent(s) in obtainin permits in Cit of Zeph rhills
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<br /> ROBERT DEESE D200-762-64-171-0
<br /> LUIS PATRACAS P362-521-760-620-0
<br /> DAIKEL SUAREZ 5623-160-91-211-0
<br /> DEVIN BELLO B400-165-90-005-0
<br /> This.form.supercedes a_ny previo_usly_,submitted letter(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 /> and he information contained thereon. F�bn�
<br />' Thi� authoriiation wi�ll remain in effect until STATE OF
<br /> can� elled in writing by the,undersigned .` b i
<br /> lic.e�se holder. � ��� courrTY oF_ � �,S p��r�. , ,
<br /> I Sworn to(or affirmed)and subscribed before me this .
<br /> a��-,day of�/��e� ,20�_
<br /> by tez
<br /> (Printed/Typed ame of Li nse older king Statement)
<br /> Lic`_ se Holder's Signature N IC '11 �
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<br /> ��,���t�$��N"•��� ameofNotaryTyped,Printed,orStamped)
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<br /> ����.��� �11�'�pl��: � My Commission expires:
<br /> - JV' X v''* Personally Known d(, OR Produced Identification ��
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<br /> �//q9 �aryWbGcu�a;:O���\� (TypeofIdentificationProduced)
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