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CONTRACTOR AUTHORIZATION FORM <br /> STATE LICENSE NO.: ��QCD R'-23� <br /> PRINT QUALIF1ER'S.NAME: AoArtt,3 <br /> BUSINESS NAME: +lamI FIR-0-4-l`, s <br /> I authorize the following individuals to sign for and obtain permits: (Please print names clearly.) <br /> ARIEL BULLINGTON <br /> JACOB HODGES <br /> DEBORAH PLATTHY <br /> Signature of Qualifier. <br /> Late: 1 <br /> State of Florida <br /> County of <br /> Sworn to arld subscribed before this day f <br /> otary u lic State orida <br /> (Stamp} <br /> My commission expires I� trf r'1 <br /> ��`" . <br /> , 0"rt Notary Public State of Florida <br /> Thottsy Coffey <br /> My Commisairm GG 246571 <br /> q Explrea oaii=022 <br /> _ Scanned by CamScanner <br /> •.�l4an.+}>.t�'..-. "Rsa. ;:a.^r,i '1 - :1.t:`..+i;l,'. � •�,. �.: t f=i',.�yX•. <br /> <�Si:.. i45t "3riY:�:.c:�.i..l`ie:i:r�aa?t!'4>•a:;��:/s`S'.r,r::�•fii %:::"+`w�C:.;r.t'•�;?'ai.i„' ;Y:i• ?`�;,.t:TM:%"s:;nY? ::�.'1'^"' <br /> .. .. ... .,.:.�tird.:.�'7ts;'sk..v'?{•q'x":�:.iXtnL�.9.....�. <br /> ■ <br />