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. , i - , <br /> 1_ - <br /> ��f�lS� �ommercial Ro fing, Inc. � <br /> License t�ko.CCC-037007 Phone{863J 225-5953 <br /> FAX(863}337-5260 <br /> P.O.BOX 1128 <br /> LAKELAND,FLORIDA 338D2 <br /> PERM[T A TFIORIATION FORM <br /> [,Larry A Dempsey,hereby authorize; � , <br /> to obtain a roofng permit in my tiehalf for the j b si escribed elo �: <br /> Job Descriptiao• r'' <br /> dob Address• �[��I �1�C3. <br /> � ` i <br /> Job CitylS'�YZip:� ri � �� <br /> � �. <br /> Date: i] <br /> Emplo ee nature <br /> Date-� <br /> ar , D mpsey <br /> State Certification#CCC 0370t17 <br /> I <br /> i <br /> S7'ATE OF FLORLDA <br /> �OUNTY O�'POLK <br /> The foregoing iustrument was a��wtedged b ore me this�day oE ,20�by <br /> Larry A Dempsey who has produced a k'lorida rivers Licedse as identifica ' n and who did take the <br /> oath. I <br /> � <br /> . . � <br /> IYota „ Pu6hc� ;,�;�'�'t`��,_ NkEL1SSA S. HAMILTON , <br /> State of Florida -�'�j�: Notary Public,State of florida <br /> �y;..,,��.,-.:��� h1y:omm,expires Nov.21,2420 <br /> � � �'%ti�����`�' Ga^�r�ission Number GG495d0 <br /> Print Name:��i�_� ��i n�. <br /> 'Fitle: 1'��-�-6.�'U, � <br /> Commission No- �i.�es`�'1�_�� <br /> � <br /> Dempsey C rr�mercial Roofing, Inc. <br /> � <br /> Stat�e Li ense #CCC-037007 <br />