Laserfiche WebLink
CROWN Crown Castle <br /> CCCASTLE 4511 North Himes Avenue,Suite 210 <br /> Tampa,FL 33614 <br /> Date: 1/23/19 <br /> Municipality: City of Zephyrhills <br /> Name of license holder: Adam Ehrlich <br /> County Certificate # or State License# SCC1 31 1 52078 <br /> The following person(s) are authorized to sign for permits for the above referenced license holder. <br /> All person(s) authorized to sign must produce a valid Driver's License or Government issued photo <br /> ID card and a Photo with this application. This Authorization is for All Permit Submittal and Permit <br /> Pickup. <br /> Names: Please Print Driver License <br /> Kevin DePatie D130-517-78-128-0 <br /> Alex Van Vlaenderen V514-012-91-248-0 <br /> Terri Anello A540-800-70-784-0 <br /> Trisha Purcell P624-801-81-850-0 <br /> Jeff Stephens 1309685 (Northern Territory of Australia) <br /> Deborah platthy P430-170-61.589.0 <br /> Authorization to s re good 12 months of dated form. <br /> (Signat - Contracto <br /> Commonwealth of Pennsylvania <br /> COUNTY OF <br /> Sworn to(or affirmed)and subscribed before me this ti day of Jan ,-7 (year), <br /> by °� L'f 1 G�, (name of person making <br /> statement). <br /> (Signature of Notary Public-State of Florida) GALE LOGAN <br /> €. � COMMISSION ft GG 121026 <br /> EXPIRES;July 4,2.021 <br /> (Print,Type,or Stamp C mmissioned Name of Notary Public) shfP�`' 0ordadTbru t°t'pub{iCUnaenvd[" <br /> Personally Known OR Produced Identification <br /> The Foundation for a Wireless World. <br /> CrownCastle.com <br />