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CENTRAL AIC do HEAT 9402 E US HWY 92,Ste 102 <br /> Tampa, FL 33610 <br /> EASYA/C Phone(813)635-0440 <br /> Fax(813)635-0480 <br /> "Comfort Made Easy" www.easyac.net <br /> Lic.#CAC058174 <br /> A Division of 3G Air Conditioning&Heating,Inc. <br /> .. .�:. ':GIN H4�2I7A2I;C?NFFOR 'I <br /> ALL;-TNFORMATIONIS"A''I PJ D-:0-,ktEGIBX ;Y !RIN"I'ED <br /> I, Keith Westbrook CAC058774 , <br /> (Contractor's Name)NOT COMPANY NAME (Contractor's License No.) <br /> hereby authorize the following to act as my agent(s) in obtaining permits in Cro F Z ��,11-S <br /> Florida. <br /> r:Name pf Agent Driver's License No. <br /> aw <br /> T'hiss.forrri�asupersedes�'anyprey'ioi�sl":y,�.,s `lmttied�letter(s),`of�athorizatiori <br /> This form must contain only the people you want to pull permits in your name.To make changes to this form,you must submit a new form.This <br /> form will delete and replace any previous authorization form and the information contained thereon. <br /> This autliorizatcn will=rema <in STATE OF FLORIDA <br /> e0 '-fu itif cancelledrinswrit rig by COUNTY OF HILLSBOROUGH <br /> the i%rideisigried`li_cense holier. <br /> Sworn to (or affirmed) and subscribed before me <br /> this , day of , 20 by <br /> Keith Westbrook <br /> (Printed/7yped Name of License Holder Making Statement <br /> tense Holder's Signature NO UDC <br /> (Signature of No ry) <br /> Affix (Name of Notary Typed, Printed,or Stamped) <br /> Notary y Commission expires: <br /> ........:4'". <br /> SHARON S VARBRouGA ersonally Known X OR Produced <br /> •( MY COMMISSION#FF166514I lentification <br /> EXPIRES October 7,2018 (Type of Identification Produced) <br /> d0r.r-oiDo FlorldnNotaryService,corn <br /> Keith A.Westbrook <br /> Contractor-CAC058774 <br /> r— <br />