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To:City of Zephyrhilis Page 6 of 6 2018-07-18 20:25:50(GMT) 15014210814 From:Solution Source Inc. <br /> 01 UTION" <br /> :ti.• ° :y <br /> S:�t��>fFkoricf�t.icc�n5ecic �•`+ �''� 1� 3":,r, ~' t1 �1vBCentrbl.[7r. <br /> ,�i11i'3Yv1't..ESl7}I5t311. '°�. �' "__ `. •(, .. �: .I"{arlt[1'ii}f;i~l.w3;it?b. <br /> r�Csa7tncr E;OnErat:Ftfi' '�'-?� .. "':�_ ... ,:•, ,. iF'hcntra 81;::;i���fi3� <br /> CC f"'133?4J{1 i (Fri::}01,421,0814. <br /> ''.SIGNATURE hUTH RI'TY' .......... <br /> FORM F Old TM E <br /> 'PURPOSE OF OBTAINING <br /> BUILDING PERMIT ... <br /> Shawn lemison C C133 ,001 .solution Source RooQ <br /> (PrtiniNameHere) (Print Business Nam.q.Herc) ........ <br /> do hereby designate the following individual(s)as having the authority to sign and submit applications and related documents for the <br /> pw-pose of obtaining building permits under my Contractor Cert'rticate of Competency. I further acknowledge and accept,as a licensed <br /> contractor,my responsibility,and liability for each project permitted under the authority designated on this form which supersedes <br /> acid repeals all other previously subrnitted signature authorlify forms,•and that nay failure to assume and fulfill said deity may tx <br /> -grounds for the initiation ofdisciplinaly action against my contractor's license. <br /> DE-91GNA.7TU STG1_ ERS: (X'•LEASE? PRINT): <br /> 1.) Sammantha Temison <br /> Designated signers irraybet trlrciitrbpravidaxp►operitlentif;catirrnattlre+equertofthel7e;niitaf:ice.7irenntnheraf e i na s_iener t ynot <br /> `l'hisoriginaifm• rrtustbe submitted for desihnratingsignatureattthority,yo rsnustreturrthisformw•iththeORIGINAL notary seal to our office. No <br /> copiesorfaxes eacce 'e.are happy to-provide this service;howevei,,we're.sprrethe rightto suspend this sezviceatanyRine due toitsabuseor <br /> misust <br /> shammmison <br /> State of Florida,County of W)1_4s rrns� h . <br /> Sworin to.(or affirmed)and subscribeii'before me this day of t i1,1 20 <br /> by S 1 iit�n�fii`aon whois <br /> ersonaIty lrnowna me or who has produced (type of ID)as identification. <br /> RY°4* ClNDY ANN EMCH <br /> tI f-.1' i r• r � 'i Notery Puh!!c State at Flatida <br /> 4: <br /> Signature of Notary Public State of Florida Pri'b€t�, Jper WI tram f Notary <br /> or t rough a tiao t ( Assn. <br /> My Commission Expires, 1 flo-0.e <br /> : <br /> r€� rr.�rzy o trticrns'ourc:exctrn--c air risCo my-srrliri;iOrrsourr:r::i csin <br />