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� � <br /> c� � � , <br /> �� - <br /> � � m ," �Df � � s <br /> PERMIT AGENT AUTHORIZATION FORM � <br /> ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED <br /> I, Anthony Gonzalez CAC1816958 <br /> (Contractor's Name) NOT COMPANY NAME (Contractor's License No.) <br /> hereby authorize the following to act as my agent(s) in obtaining permits <br /> in C_'���-� c�-� Z.��tn�, �-�i�LIS <br /> , ;.;:. <br /> ` `` Name of A erit: , '- "°" `��� ,, Driver's Cicense No. ''�"`` <br /> ROBERT DEESE D200-762-64-171-0 <br /> LUIS PATRACAS P362-521-760-620-0 <br /> BAR�ARO SUREZ 5623-076-90-191-0 <br /> CFIRISFIELL ROJAS R220-104-89-745-0 <br /> BERNICE VIBBERT V163-073-79-718-1 <br /> REDDY GONZALEZ ' P625-734-73-260-0 <br /> This form supercedes any previously 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 the information contained thereon. � <br /> This authorization will remain in effect until STATE OF F�p r�C�c:�. <br /> cancelled in writing by the undersigned <br /> license holder, courrTY oF _�i��5 bOr o��r� <br /> Sworn to(or affirmed)and subscribed before me this <br /> �� ,day of �Ci'�b v,1�� ,20 �� <br /> bY �6�`E'�.�,'�v�.e ��-Z(9�/�.Z�Ps Q9-`Z_ <br /> (Printedlfyped Nam of License Holder Making Statement) <br /> Lice se Holder s Signature NOTARY PUB C <br /> (Signature Notary) <br /> .•''�ti���" CHAISHELLDANIELLEROJAS ����S P L P`� ��� �� <br /> ������t (Name of Notary Typed, Printe,or Stamped) <br /> =?. ` No;aryPublic-StateofFlorida ���'� <br /> :•: •- Comm�ssio�=GG t26,a,2�r � My Commission expires: <br /> =:s9�,yFr_ac:' MyComm.Ex�ires1u13B1�f%JC Personally Known�OR 12r�duced Identification <br /> �..,. Bcrded thrcucF haticral <br /> Sea/ � <br /> (Type of Identification Produced) <br />