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CONTRACTOR AUTHORIZATION FORM , <br /> STATE LICENSE NO.: CCC I 3���3 q <br /> PRINT QUALIFIER'S NAME: �G'M� ��SC��- <br /> BUSINESS NAME: M C —' COC1 <br /> I authorize the following individuals to sign for and obtain permits: (Please print names clearly.) <br />� b eS � <br /> i <br /> Signature of Qualifier: Date: 1 <br /> ,'- F " <br /> State of Florida <br /> County of <br /> Sworn to and subscribed before this day � � I� �1� <br /> � ` �� ate of Florida <br /> (Stamp) . <br /> My commission expires y—�-�q ' .. ��i�,�=: <br /> .c7`.•'.h. <br /> _a. ,�, •�n� STEPFIANIE g�P����--I <br /> :T�,.�: NiY COMMIS$ION#�'r.� <br /> ,: "•�;4k n?.`�`' EXP1 �B�l�7 � <br /> _ ��u�,�s;-o',s �S�'1 U7.2018 <br /> —- F�aanr�y,se„tic�s�,, <br />