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19-21210
Zephyrhills
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2019
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19-21210
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Last modified
1/8/2020 10:11:34 AM
Creation date
1/8/2020 10:11:34 AM
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Building Department
Company Name
SILVERADO
Building Department - Doc Type
Permit
Permit #
19-21210
Building Department - Name
SIMMONS,ELIZABETH ANN
Address
6788 WAGON TRAIL ST
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Fence Outlet Port Richey LLC. <br /> 11507 US Hwy 19 <br /> Port Richey FL 34668 <br /> Office (727) 857-7590 <br /> Fax (727) 857-7590 <br /> AUTHORIZED AGENT "FORM <br /> I,Jeffrey Tinnon,:of Fence Outlet Port Richey LLC having personally appeared for identification, do <br /> hereby authorize the following to act as my Agent(s)in submitting Permit Applications in the area of <br /> City of Zephyrhills. <br /> (1) <br /> Brandie Sizemore <br /> (2) <br /> Justi Gray <br /> (3) <br /> I UNDERSTAND THAT I AM THE LICENSED QUALIFIER RESPONSIBLE FOR THE APPLICATION AS <br /> SUBMITTED By MY AGENT(S),AS REFERENCED ABOVE. I FURTHER ACKNOWLEDGE THAT THIS <br /> ORIGINAL AUTHORIZATION FORM IS IN MY LICENSE OR QUALIFICATION FILE FOR LEGAL REFERENCE <br /> PURPOSES. <br /> x x May 13,2019 C10252 <br /> Co r ctor s Signature Date Registration/Certification/License Number <br /> NOTICE: THE LICENSED CONTRACTOR'S SIGNATURE IS TO BE NOTARIZED <br /> State of Florida <br /> County of Hillsborough <br /> The foregoing instrument was acknowledged before me this 13 day of May 2019 <br /> By Jeffrey Tinnon ,as Vice President of Fence Outlet Port Richey LLC.and is personally know tome. <br /> " a_�V� <br /> Notary's Signa, e <br /> ----- - <br /> Commission Expires: H�:Y'1 PENNY FERNANDEZ <br /> _' W COMIAMION 0 CG-111686 <br /> Pg' EXPIRES:OdoWr'3,2021 <br /> ,iR.' BMW Th+u Plotary ftk Undewdlers <br />
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