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LIMITED POWER ® RNEY <br /> Date: a�Co <br /> i hereby name and appoint: <br /> \c � <br /> an agent of: SUIA Q�10U c )- T—L. <br /> (Name of Company) I <br /> to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things <br /> necessary to this appointment for(check only one option): <br /> 0 All permits and applications submitted by this contractor. <br /> 0 The specific permit and application for work located at: <br /> (Street Address) <br /> Expiration Date for This Limited Power of Attorney:_ Il C) j �j�' ` q <br /> License Holder Name: ( ,�(� <br /> State License Number: <br /> Signature of License Holder: <br /> STATE OF FLOIUD�A(]Q <br /> COUNTY OF.'XI'� �nCL, <br /> The foregoin instrur ent was acknow edged befo�e me this day of , <br /> 20A, by a rf MQ I ( � C who is personally known i <br /> to me or o who has produced as <br /> identification and who did(did not)take an oath. <br /> I <br /> ea\r <br /> (Notary Seal) �' <br /> Print or type name <br /> ASHIEYBOWEN Notary Public- State o ors q <br /> '• "„Commtsslon p GG 333177 Commission No. 3 �} <br /> 'Expires May 12.2023 M Commission Ex Tres:8ondsd Thru Twy Fain in eurence 800.385.7019 y P <br /> (bAj-k-� <br /> f� F <br /> Rev.3/27/07 <br />