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CONTRACTO UTHO ZATION FORM <br /> STATE LICENSE NO.: j 1�11,xfv e G1 3G0 to 1 <br /> PRINT QUALIFIER'S NV=-NALQD NER <br /> BUSINESS NAME: DON WARNER ELECTRIC <br /> I authorize the following individuals to sign for and obtain permits: (Please print names clearly.) <br /> JACOB HODGES ANDREA O'CONNELL <br /> STACY GRAVES <br /> I <br /> I <br /> ARIFL RUI_LINGTON <br /> TIM COFFEY <br /> Signature of Qualifier: Date: 5/29/18 <br /> State of Florida <br /> County of 5/29/18 <br /> Sworn to and subscribed before this day <br /> ry P c State o lorida <br /> (Stamp) 4-7-19 <br /> My commission expires <br /> STEPHANIE STEPHENS <br /> My COMMISSION#FF218087 <br /> 9; F EXPIRES April 07,2019 <br /> !1U/ 328-�'y <br /> •-- _ Honr1allo,ays@ry)CB.Cony . <br />