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f <br /> Fort Knox Fire and Communications, Inc. <br /> 5005 North Clark Avenue,Tampa,FL 33614 <br /> Phone#813-653-1605 Fax#813-653-1710 <br /> EF20000876 <br /> .E� <br /> City of Zephyrhills-Building Dept <br /> 5335 81h Street, Zephyrhills, FL 33542 <br /> CONTRACTOR AUTHORIZATION FORM <br /> STATE LICENSE NO.: EF20000876 <br /> PRINT QUALIFIER'S.NAME: Sean Collins <br /> BUSINESS NAME: Fort Knox Fire&Communications <br /> *THIS AUTHORIZATION SUPERSEDES ALL PREVIOUS SUBMITTED AUTHORIZATIONS* <br /> I authorize the following individuals to sign for and obtain permits: (Please print names clearly.) <br /> TOW <br /> 4�t /A1 C O j <br /> Signature of Qualifier: - Date: ! <br /> NOTARY: <br /> State of <br /> County of- <br /> Subscribed and sworn to befg e m on this day o in the year 2 D ---by <br /> (Nar loocum.e er <br /> Not`ry.-P i l` ff <br /> Type r Printed NameC 1C <br /> My Commission Expires' - <br /> N1Y�_ FEL`IC MITCHELL <br /> '=MY cOMMISSION#0GO60543 <br /> EXPIRES January os 2o2i <br />