Laserfiche WebLink
� <br /> .$'=�. <br /> {-�Oi11£' ��!"i`Oi'I7I��6iC� <br /> ALLIAN C E <br /> PERMIT AGENT AUTHORIZATION FORM <br /> I, Thomas Lippert, am the License Holder of Home Performance Alliance, <br /> doing business in ���.�C'�.����� , Florida, License Number <br /> CGC 15058826, and herby authorize Ernest Orozco to act as my agent <br /> and, in my absence, give authority to sign for permits on my Company's behalf. <br /> Property Location <br /> t� --� �a �--E-��h���s -P�.-�� <br /> THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTILL A NEW PERMIT <br /> AUTHORZATION FORM IS EXCUTED AND SUBMITTED NEW THE LICENSE <br /> HOLDER TO THE ABOVE COUNTY BUILDING DIVISION. <br /> I ^ -�� L <br /> icense Holder ame Signature <br /> i <br /> STATE OF FLORIDA <br /> COUNTY OF PINELLAS <br /> I HEARBY CERTIFY that on�day of � , 2017, before me personally <br /> appeared Thomas Lippert,the license holder, who is personally known to me. <br /> Christv Farrish �� /� ` � <br /> Notary ignature <br /> :����r P4B�"' <br /> _� �;:: CHRISTY FARRISH <br />� ``' - MY COMMISSION#FF115185 <br /> :� o.;: <br /> '°•.',�aFnci!;.� EXPIRES Apri!25, 2018 <br /> �ao7)39a-0�53 FloridallotaryService.com <br /> Home Pertormance Alliance, Inc. – 2850 Scherer Dr., Suite 550—St. Petersburg, FL 33716 Tel: <br /> 727-538-4140– Fax: 727-538-4217 <br />