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� � PO Box 271450 Tampa, FL 33688-1450 <br /> � i Office 813.264.6262 <br /> Fax 813.264.6224 <br /> PREC610N ROOFNG SOLUTIONS FL Lic. No. CCC057428 <br /> CGC1523359 <br /> CONTRACTOR AUTHORIZATION FORM <br /> STATE LICENSE NO.: CCC057428 <br /> PRINT QUALIFIER'S NAME: Daniel W Dalfino <br /> BUSINESS NAME: Precision Roofing Solutions, Inc. <br /> *THIS AUTHORIZATION SUPERSEDES ALL PREVIOUS SUBMITTED AUTHORIZATIONS* <br /> I authorize the following individuals to sign for and obtain permits: (Please print names clearly.) <br /> ' Allen Marquis, Joe Glennon <br /> Lee Bussey, Tad Denny <br /> Josh Smith <br /> Signature of Qualifier: , (,�,� ' Date: � , <31 �o <br /> State of Florida <br /> County of Pasco , <br /> Sworn to and subscribed before•this day u���r 3 l lo t S� <br /> `�Y,6y�' _ <br /> JOE GLENNON <br /> '.: .: MY COMMISSION H FF 202463 <br /> _ "'-�,�'•,. �: EXPIRES:April13,2ois - Notary Public State of Florida <br /> �qf,�' Bonded Thru Notary Pubfic Underwriters <br /> � (Stamp) � � � , . , <br /> My commission expires �-��•.� �3 , ;}���5 <br /> � <br />