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CROWN Crown Castle <br /> CCASTLE 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 31152078 <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 /> Authorization fo s re good 12 months of dated form. <br /> (Sig nat Contracto. <br /> Commonwealth of Pennsylvania <br /> COUNTY OF cb/'o(��rA <br /> Sworn to (or affirmed) and subscribed before me this v day of ,J C4n (year), <br /> by �. L'`� c G/1, (name of person making <br /> statement). <br /> (Signature of Notary Public-State of Florida) � :�►��: �;. GALELOGAN <br /> MY COMMISSION Al GG 121026 <br /> _.+ oaf EXPIRES;July 4,2021 <br /> (Print,Type,or Stamp C mmissioned Name of Notary Public) Rft SandedThruNOMPublicUnderwMms <br /> Personally Known OR Produced Identification <br /> The Foundation for a Wireless World. <br /> CrownCastle.com <br />