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CONTRACTOR AUTHORIZATION FORM <br /> EC13009020 <br /> STATE LICENSE NO.: <br /> PRINT QUALIFIER'S NAME: NORMAN PURKRY <br /> BUSINESS NAME: SOLAR BEAR <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 /> DEBORAH PLATTHY JORDAN MILLER <br /> STEPHANIE COFFEY (STEPHENS) STACY GRAVES <br /> ARIEL BULLINGTON TIM COFFEY <br /> JEFF STEPHENS <br /> Signature of Qualifier: Date: 9/8/19 <br /> State of Florida <br /> County of Pasco <br /> Sworn to and subscribed before this day 9/8/19 <br /> l�o►�U <br /> �- Notary Public State of Florida <br /> Stam .,0 Notary audio stare of Florida <br /> p) "`� imolny coffC <br /> My commission expires �� ; �T 24MI <br /> g/devsvcsdocuments\1-documentspecialists\bcs\bcsforms\Contractor Authorization Form Revised 4/3/17 <br />